氟伐他汀及联合缬沙坦对心房颤动的疗效观察

发布时间：2018-08-28 17:27

【摘要】：目的:1、观察氟伐他汀及联合应用缬沙坦对高血压合并非永久性心房颤动的上游治疗效果;2、观察氟伐他汀对阵发性心房颤动的临床效果。方法:1、入选2013年2月至2016年7月就诊于天津医科大学第二医院、天津市人民医院、天津市东丽医院等8个中心的门诊及住院部的确诊为高血压合并非永久性房颤患者共143例,随机分为三组:钙拮抗剂(CCB)组(n=47),CCB+氟伐他汀组(n=46),缬沙坦+氟伐他汀组(n=50)。治疗方案:CCB组使用二氢吡啶类,但局限于使用氨氯地平、硝苯地平和非洛地平。氟伐他汀+CCB组:氟伐他汀40~80mg q.n.+CCB;氟伐他汀+缬沙坦组:氟伐他汀40~80mg q.n.+缬沙坦,三个组均治疗随访24个月。观察三个治疗组治疗24个月后的窦性心律维持率、持续性房颤的发生率、房颤负荷及心率变异性,并监测三组治疗前后左房内径(left atrial diameter,LAD)、超敏C反应蛋白(high sensitive C reactive protein,hs-CRP)、血脂指标(TG,TC,LDL-C)以及肝、肾功能的变化。2、入选2014年7月至2016年7月就诊于天津医科大学第二医院门诊的确诊为阵发性房颤的患者共80例,随机分为观察组(n=40)和对照组(n=40)。对照组服用抗心律失常药物,观察组在对照组的基础上加用氟伐他汀,观察并比较两组治疗1年后的窦性心律维持率、持续性房颤的发生率以及治疗前后的LAD、hs-CRP、血脂、肝肾功能等指标变化。结果:1、治疗观察24个月后,实际完成整个研究的患者共134例:CCB组(n=41),CCB+氟伐他汀组(n=45),缬沙坦+氟伐他汀组(n=48)。三个治疗组在年龄、性别、吸烟、饮酒、糖尿病、脑卒中、抗心律失常药物用药史等临床资料及血糖、心肌酶(CK-MB、cTnI)、NT-ProBNP、血压、肝功能(ALT、AST)、肾功能(Cr)、血脂(TG、TC、LDL-C)水平等血生化资料方面无显著统计学差异(P0.05),具有可比性。(1)氟伐他汀+CCB组、氟伐他汀+缬沙坦组治疗后的窦性心律维持率高于CCB治疗组(77.78%,79.19%vs 43.90%),持续性房颤发生率显著低于CCB治疗组[5(11.11%),4(8.33%)vs 13(31.71%)],差异有统计学意义(P0.05);(2)治疗后氟伐他汀+CCB组、氟伐他汀+缬沙坦组较CCB组阵发性房颤持续时间百分比缩短,分别为[8.4%(5.8%,14.4%),10.4%(4.5%,13.9%)vs 23.4%(15.4%,29.8%)](P0.05);(3)治疗后氟伐他汀+CCB组、氟伐他汀+缬沙坦组的f-f间期较前延长,f波振幅较前增高(P0.05),而CCB组f-f间期及f波振幅较前无明显统计学差异(P0.05);(4)CCB组治疗前后血脂指标及hs-CRP水平、左房内径大小均无统计学差异(P0.05),氟伐他汀+CCB组、氟伐他汀+缬沙坦组治疗后上述指标较治疗前均明显降低(P0.05)。(5)三个治疗组治疗前后肝、肾功能无明显统计学差异(P0.05)。2、治疗观察12个月后,实际完成整个研究的患者共74例:氟伐他汀观察组(n=38),对照组(n=36)。两组在年龄、性别、吸烟、饮酒、糖尿病、脑卒中、抗心律失常药物用药史等临床资料及血糖、心肌酶(CK-MB、cTnI)、NT-ProBNP、血压、肝功能(ALT、AST)、肾功能(Cr)、血脂(TG、TC、LDL-C)水平等血生化资料方面无显著统计学差异(P0.05),具有可比性。治疗1年后,氟伐他汀观察组的窦性心律维持率显著高于对照组(84.21%vs61.11%),持续性房颤发生率低于对照组(5.26%vs 22.22%),差异具有统计学意义(P0.05)。对照组治疗前后血脂指标及hs-CRP水平、左房内径大小均无统计学差异(P0.05),而观察组治疗后上述指标较治疗前均明显降低(P0.05)。观察组治疗后血脂指标、hs-CRP水平及左房内径大小显著低于对照组,有统计学差异(P0.05)。两组治疗前后肝、肾功能指标无统计学差异(P0.05)。结论:非永久性心房颤动患者在常规抗心律失常治疗的基础上加用氟伐他汀或氟伐他汀联合缬沙坦,在降低血脂指标的同时,可进一步提高窦性心律维持率,减少持续性房颤的发生率,降低房颤负荷,改善心房重构,减少炎症反应,未增加肝、肾功能损害等不良反应,可用于心房颤动的二级预防和治疗。
[Abstract]:Objective: 1. To observe the upstream effect of fluvastatin and Valsartan in the treatment of hypertension with non-permanent atrial fibrillation; 2. To observe the clinical effect of fluvastatin on paroxysmal atrial fibrillation. Methods: 1. Patients were enrolled in the Second Hospital of Tianjin Medical University, Tianjin People's Hospital, Tianjin Dongli Hospital from February 2013 to July 2016. 143 patients with hypertension and non-permanent atrial fibrillation were randomly divided into three groups: calcium antagonist (CCB) group (n = 47), CCB + fluvastatin group (n = 46) and valsartan + fluvastatin group (n = 50). Fluvastatin + CCB group: Fluvastatin 40-80mg q.n. + CCB; Fluvastatin + Valsartan group: Fluvastatin 40-80mg q.n. + Valsartan, all three groups were followed up for 24 months. The maintenance rate of sinus rhythm, incidence of persistent atrial fibrillation, load of atrial fibrillation and heart rate variability were observed after 24 months of treatment in the three groups. Eighty patients with paroxysmal atrial fibrillation admitted to the Second Hospital of Tianjin Medical University from July 2014 to July 2016 were randomly divided into observation group (n=40). The control group was treated with antiarrhythmic drugs and the observation group was treated with fluvastatin on the basis of the control group. The maintenance rate of sinus rhythm, the incidence of persistent atrial fibrillation and the changes of LAD, hs-CRP, blood lipids, liver and kidney function before and after treatment were observed and compared between the two groups. A total of 134 patients completed the study: CCB group (n = 41), CCB + fluvastatin group (n = 45), valsartan + fluvastatin group (n = 48). (Cr), blood lipids (TG, TC, LDL-C) levels and other blood biochemical data were not significantly different (P 0.05), with comparability. (1) Fluvastatin + CCB group, fluvastatin + valsartan group after treatment sinus rhythm maintenance rate was higher than CCB group (77.78%, 79.19% vs 43.90%), the incidence of persistent atrial fibrillation was significantly lower than CCB group [5 (11.11%), 4 (8.33%) vs 13 (8.33%). 31.71%], the difference was statistically significant (P 0.05); (2) after treatment, fluvastatin + CCB group, fluvastatin + valsartan group paroxysmal atrial fibrillation duration percentage shorter than CCB group, respectively [8.4% (5.8%, 14.4%), 10.4% (4.5%, 13.9%) vs 23.4% (15.4%, 29.8%)] (P 0.05); (3) after treatment, fluvastatin + CCB group, fluvastatin + valsartan group f-f interval was shorter than before treatment; (3) fluvastatin + CCB group, fluvastatin + valsartan group The F-wave amplitude increased significantly (P 0.05), while the f-f interval and F-wave amplitude of CCB group had no significant difference (P 0.05); (4) There was no significant difference in serum lipid index, hs-CRP level and left atrial diameter before and after treatment in CCB group (P 0.05). In fluvastatin + CCB group, fluvastatin + valsartan group, the above indexes were significantly lower than before treatment (P 0.05). (5) There was no significant difference in liver and kidney function between the three treatment groups before and after treatment (P 0.05). After 12 months of treatment, 74 patients actually completed the study: fluvastatin observation group (n = 38), control group (n = 36). The two groups in age, sex, smoking, drinking, diabetes, stroke, antiarrhythmic drug history and other clinical data and blood. Blood biochemical data such as glucose, cardiac enzymes (CK-MB, cTnI), NT-ProBNP, blood pressure, liver function (ALT, AST), renal function (Cr), blood lipids (TG, TC, LDL-C) were not significantly different (P 0.05), and were comparable. After one year of treatment, the maintenance rate of sinus rhythm in fluvastatin group was significantly higher than that in control group (84.21% vs 61.11%). The incidence of persistent atrial fibrillation was low. In the control group (5.26% vs 22.22%), the difference was statistically significant (P There was no significant difference in liver and kidney function between the two groups before and after treatment (P 0.05). Conclusion: Fluvastatin or fluvastatin combined with valsartan in patients with non-permanent atrial fibrillation on the basis of routine antiarrhythmic treatment can further improve sinus rhythm and reduce blood lipid index. Holding rate, reducing the incidence of persistent atrial fibrillation, reducing the load of atrial fibrillation, improving atrial remodeling, reducing inflammation, without increasing liver and kidney function damage and other adverse reactions, can be used for secondary prevention and treatment of atrial fibrillation.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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