依那普利对房颤的干预

A study on the intervention effect of enalpril on atrial fibrillation

目的:通过观察阵发性和持续性房颤患者口服依那普利前后左心房内径、P波离散度、心钠素(ANP)的变化,探讨依那普利对房颤的干预作用及其预防机制。方法:阵发性和持续性房颤患者60例,分为治疗组和对照组各30例。恢复窦性心律后均口服抗血小板药物,治疗组加用依那普利5～10mg/d;对照组不加用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂类药物。治疗18个月,房颤复发为终点。观察2组治疗组前后左心房内径、P波离散度、ANP的变化。结果:治疗组房颤复发率低于对照组(11.1%比35.7%,P<0.01);左心房内径治疗小于对照组[(39.4±5.3)mm比(44.5±5.1)mm,P<0.01];P波离散度治疗组较对照组明显降低[(43.8±7.8)ms比(51.9±9.8)ms,P<0.01];ANP治疗组较对照组明显降低[(128.8±33.5)pg/mL比(165.7±32.1)pg/mL,P<0.01]。结论:长期服用依那普利能逆转左心房扩大,降低左心房压力,防止房颤复发,影响心房重构。

Objective To study the intervention effect of enalpril on atrial fibrillation by observing the changes of left atrial diameter, P wave dispersion and serum atrial natriuretic polypeptide （ANP） level before and after oral administration of enalpril in patients with paroxysmal and persistent atrial fibrillation, nethodes Sixty patients with paroxysmal and persistent atrial fibrillation were divided into two groups, enalpril group and control group. Anti-platelet drugs were given to all these patients after returning to sinus rhythm. Enalpril 5-10 mg/d was given in enalpril group. Angjotension conversion enzyme inhibitor and angiotension 11 receptor blocker were not used in control group. Patients were followed for 18 months and the study end point was relapse of atrial fibrillation. Results Sinus rhythm maintenance rate was significantly higher （11.1% vs 35.7%, P〈0.01） and left atrial diameter was significantly less in enalpril group than that in control group [（39.4±5.3） mm vs （44.5±5.1） mm], P wave dispersion and serum ANP were significantly less in enaprll group than that in control group [（43.8±7.8） ms vs （51.9±9.8） ms and （128.8±33.5） pg/mL vs （165.7±32.1） pg/mL, P〈0.01]. Conclusions Long-term use of enalpril can reverse the enlargement of the left atrium, reduce its pressure, prevent the relapse of the atrial fibrillation and influence the remodeling of the atrium.