房颤患者脑钠素、血管紧张素Ⅱ的变化及氯沙坦的干预作用

The Change of Plasma Brain Natriuretic Peptide Angiotensin II in Patients with Atrail Fibrillation and tne Intervention of Losartan

目的：探讨房颤患者脑钠素、血管紧张素Ⅱ的变化及氯沙坦在房颤中的治疗价值。方法：入选患者分为对照组（窦律）40例、永久性房颤组46例、阵发性房颤组40例。阵发性房颤组服用可达龙及氯沙坦,永久性房颤组服用氯沙坦及钙离子拮抗剂控制室率,分别检测各组治疗前后左心房内径及血清脑钠素、血管紧张素Ⅱ水平,进行对照分析。结果：（1）永久性房颤组血脑钠素（BNP）、肾素（PRA）、血管紧张素（ANG）Ⅱ水平及平均左心房内径（LAD）与对照组比较增加（P〈0.05）;阵发性房颤组血BNP、PRA、ANGⅡ与对照组比较升高（P〈0.05）,LAD与对照组比较有升高趋势,但无统计学意义（P〉0.05）。（2）房颤组血BNP水平与左房内径、血管紧张素Ⅱ浓度明显相关（r分别为0.362,0.294,P〈0.05）。（3）永久性房颤组和阵发性房颤组经氯沙坦干预后血BNP水平降低（P〈0.05）,而血浆PRA、ANGⅡ水平升高（P〈0.05）。（4）氯沙坦干预能提高窦律维持率（P〈0.05）,可降低47%的房颤复发危险（RR=0.45,95%可信区间0.260～0.749,P〈0.05）。结论：房颤患者血脑钠素水平的升高可能与房颤的心房重构有关,氯沙坦可能通过干预房颤的心房重构降低脑钠素水平并降低阵发性房颤的复发。

Objective： To explore the association between plasma brain natriuretic peptide（BNP）and angiotensin II（Ang II）,and to assess the clinical efficancy of losartan in patients with atrial fibrillation（AF）.Methods：All patients were divided into three groups：group 1（sinus rhythm group,n=40）was control grouop,group 2（permanent AF group n=46）was treated with calcium antagonists plus losartan,group 3（paroxysmal AF group n=40）was treated with amiodarone or amiodarone plus losartan,The left atraial diameter（LAD） and plasma BNP、AngII were measured after and before treatment.Results：（1）The level of BNP、AngII、renin and LAD in permanent AF increased significantly than control group（P〈0.05）;the level of BNP、AngII、renin in paroxysmal AF increased significantly than control group（P〈0.05）,In terms of LAD,there were no signifcence between them（P〉0.05）.（2）There was a positive relationship between BNP、AngII and LAD（r=0.362,0.294,P〈0.05）.（3）The BNP、LAD of permanent and paroxysmal AF were decreased significantly after the treatment of losartan（P〈0.05）,but the plasma rennin and AngII increased significantly（P〈0.05）.（4）The maintenance of sinus rhythm in group amiodarone plus losartan was higher significantly than in group amiodarone（75% and 55%.P〈0.05）,the hazard ratio for AF recurrence in patients treated with amiodarone plus losartan was 0.47（RR=0.45,95% CI 0.260～0.749,P〈0.05）.Conclusion：The increased level of plasma BNP of AF maybe involve the structal remodeling of atrail,Losartan may interfere with AF via the atrial remodeling mechaniosa by reducing BNP levels.