Clinical effect of lovastatin in the treatment of coronary heart disease with chronic kidney disease

Coronary heart disease (CHD) is a common clinical disease in middle-aged and elderly patients. It is often combined with heart failure, which leads to myocardial hypoxia and decreased cardiac contractility. If the clinical can not give timely and effective treatment, it will lead to cardiovascular events or sudden death, which seriously threatens the life and health of patients. In patients with coronary heart disease and chronic kidney disease, the condition is more complex and the treatment is more difficult. This paper analyzes and studies the clinical effect of lovastatin in the treatment of coronary heart disease combined with chronic kidney disease.

1 materials and methods 1.1 general data 62 patients with coronary heart disease and chronic kidney disease in our hospital from July 2011 to February 2014 were selected, all of them met the diagnostic criteria of coronary heart disease. All patients had clinical manifestations of proteinuria and hematuria, and 24-hour proteinuria was 0.5-1.0g, morning urine red blood cell count > 30000 / ml, serum creatinine level < 106 ~ mol / L, blood urea nitrogen <7．1mmol/L. There were 38 males and 24 females with an average age of (69.8 ± 4.9) years and a course of 3-12 years with an average course of (6.7 ± 2.4) years. 62 patients were randomly divided into study group and control group, 31 cases in each group. There was no significant difference in gender, age, course of disease and other general information between the two groups (P > 0.05).

1.2 methods the control group was given conventional treatment. All patients were given cardiotonic, diuretic, lipid-lowering and other comprehensive treatment. Metoprolol was used to adjust the dose according to the patient's condition. The maximum dose was 100mg / D, twice a day. After prednisone combined with flutamide maintenance treatment (half dose hormone therapy), the dose of metoprolol was 0.5, 50 and 20m Island / D respectively (P < 0.05) Three days before and three days after the treatment, flutamide was added for 8 weeks. In the first 4 weeks, 2 capsules / time, twice a day, and then 1 capsule / time. The dosage was adjusted flexibly according to the bleeding tendency of patients. The patients in the study group were treated with lovastatin on the basis of conventional treatment: lovastatin tablets 20mg orally, once a day, dinner meal. The treatment lasted for 8 weeks. 1.3 observation index and curative effect evaluation standard observation index: the changes of 24-hour urine protein quantity and urine red blood cell level were recorded before and after treatment in the two groups. Coronary heart disease efficacy criteria: markedly effective: angina pectoris attack time and frequency of patients reduced by more than 80%, ECG results show that the recovery or basic return to normal; effective: angina pectoris attack time and frequency of patients reduced by 50% 80%, ECG results show that T wave inversion shallower than 50%, or from flat to upright, depress ST segment rise > 0.5mfl; invalid There was no significant change in the time and frequency of angina pectoris attack. ECG showed that ST-T had no change. Total effective rate = significant efficiency + effective rate. 1. 4 statistical methods spss20.0 statistical software was used for data analysis. The measurement data were expressed as mean ± standard deviation (x ± s) by t-test; the count data were expressed as rate (%) by t-test. P < 0.05 means the difference is statistically significant.

2 Results

2.1 the total effective rate of the study group was 90.3%, which was higher than 61.3% of the control group (P < 0.05). See Table 1.

2.2 before treatment, there were no significant differences in 24-hour urine protein and urine red blood cell phase between the two groups (P > 0.05); after treatment, the two indicators of the two groups showed a gradual downward trend, and the difference was not statistically significant (P > 0.05).

3 discussion

At present, cardiovascular and cerebrovascular diseases are the main causes of death or disability in elderly patients. Hypertension, hyperlipidemia and diabetes are recognized as high risk factors of cardiovascular complications in the world. Most cases of coronary heart disease are caused by coronary atherosclerosis, which leads to the stenosis of the artery cavity and the insufficiency of myocardial blood supply. Therefore, effective regulation of blood lipids is the key to the treatment of coronary heart disease. Studies have shown that patients with coronary heart disease coronary angiography diagnosis, found that the risk of chronic kidney disease as high as 18%, is 3.5 times the general population. Many studies have found that chronic kidney disease is an important pathogenic factor of coronary heart disease and other heart diseases. In the conventional treatment, metoprolol belongs to B receptor blocker, which selectively acts on B receptor. Studies show that metoprolol can resist the vasoconstriction produced by catecholamine, reduce myocardial oxygen consumption, delay atherosclerosis, and improve the heart function of patients. The main components of sulodexide are dermatan sulfate and aidulose Glucosaminoglycan sulfate, the ratio of which is 1:4. They can cooperate and play a strong role in the development of vascular wall After oral absorption, the adhesion amount of vascular endothelium reached more than 90%, which provided a large number of effective glycosaminoglycan (GAG) for endothelial cells, and then played a good role in antithrombotic, hypolipidemic, fibrinolytic, maintaining the permeability and selectivity of cell membrane. In the treatment of coronary heart disease combined with chronic kidney disease, we also need to pay attention to avoid aggravating renal adverse reactions and reduce the damage to renal function. Lovastatin, as an epoch-making drug for the treatment of cardiovascular diseases, its mechanism of action is to competitively inhibit the rate limiting enzyme hydroxymethylglutaryl coenzyme A reductase in the process of cholesterol synthesis in vivo, so as to reduce the synthesis of cholesterol and increase the synthesis of low-density lipoprotein receptor. The main action site is in the liver, resulting in the decrease of blood cholesterol and low-density lipoprotein In the treatment of patients with coronary heart disease and chronic kidney disease, as long as we pay attention to adjust the dose, generally will not bring renal damage. After treatment, it was found that the total effective rate of the study group was higher than that of the control group, but the renal function indexes of the two groups were improved, and the difference was not statistically significant (P > 0.05). In conclusion, the clinical effect of lovastatin in the treatment of coronary heart disease combined with chronic kidney disease is significant, which is conducive to improving clinical symptoms, reducing renal damage and improving renal function, and is worthy of promotion.