缬沙坦对慢性非瓣膜性心房颤动者左房重塑的干预研究

The effects of Valsartan on left atrial remodeling in elderly patients with chronic nonvalvular atrial fibrillation

目的观察缬沙坦对老年慢性非瓣膜性心房颤动(Af)患者左房重塑的影响并探讨其作用机制。方法选择54例老年慢性非瓣膜性心房颤动患者(病史>6月),随机分为缬沙坦组和对照组,2组常规治疗无明显差异,缬沙坦组加用缬沙坦80mg/d,疗程为12月。应用超声心动图记录50例窦性心律者(窦律组)及2组Af患者治疗前及治疗3、6、12月后左房内径(LAD),同时应用放射免疫分析法测定血清Ⅲ型前胶原末端肽(PⅢP)含量,随访治疗期间心脑血管事件的发生。结果Af患者LAD、PⅢP较窦律组明显增高。治疗前及治疗后3月、6月,2组Af患者LAD无明显差异(P>0·05);治疗12月后对照组LAD明显大于缬沙坦组(P<0·01);从治疗后6月起缬沙坦组PⅢP即有明显下降,与对照组相比差异显著(P<0·05,P<0·01);且PⅢP含量与左房内径呈正相关(r=0·4785,P<0·01);治疗期间缬沙坦组心脑血管事件发生率明显低于对照组(P<0·01)结论缬沙坦可能通过抑制心房局部肾素-血管紧张素系统(RAS),减少心肌胶原的合成与分泌,减轻心房纤维化,阻抑左房进行性扩大,改善心房顺应性,降低Af患者心脑血管事件的发生。

Objective To explore the effects of Valsartan on left atrial remodeling in elderly patients with chronic nonvalvular atrial fibrillation（Af）. Methods The 54 patients with Af were randomly divided into two groups： Valsartan group and control group, with no difference about routine treatments in both groups. Valsartan 80mg/d was added in valsartan group. The left atrial diameter（LAD） was measured in the stable sinus rhythm（SR） group（n = 50） and the two groups of Af patients before and at the 3rd, 6rd, 12rd month after treatment by doppler ultrasound, meanwhile, the level of serum pro-collagen Ⅲ （PⅢP） was measured by radioimmunoassay（RIA）. The recurrence rate of eardlocerebral events were recorded in the term of treatments. Results The LAD, PIll P in Af patients increased significantly than those in SR group. The difference of LAD was not significant between two groups of Af patients before and at the 3th month, 6th month after treatment . At the 12th month , there was significant difference between the two groups. The PⅢP decreased signifcicantly in Valsartan group from the 6th month after treatment than that in the control gTOup（P 〈0. 05 ,P 〈0.01 ）. The PⅢP was related to the LAD （r = 0. 4785, P 〈 0. 01 ）. The risk of cardioeerebral events in valsartan group was significantly lower than that in the control group. Conclusions Valsartan may prevent remodeling of left atrial in Af patients by redncing the level of myocardial collagen and delay the enlargement of the left atrium. Valsartan is helpfnl in reducing the recurrence rate of cardiocerebral events in Af patients.