卡维地洛预防阵发性心房颤动复发的疗效与安全性研究

Studies on efficacy and safety of carvedilol for preventing recurrence of paroxysmal atrial fibrillation

目的:研究卡维地洛预防阵发性心房颤动(PAF)复发的疗效及安全性,以促进其安全合理应用。方法:本研究为前瞻、随机、平行、对照研究,入选PAF患者53例,分为2组:卡维地洛(CAV)组27例和美托洛尔(MET)组26例,分别给予CAV25 mg/d和MET 50 mg/d,疗程1年。检测治疗前后外周血单个核细胞的MMP2、MMP9表达、静息心率(SHR)、左房内径(LAD)、左室舒张末内径(LVEDd)、左室射血分数(LVEF),并记录治疗1年内心房颤动(AF)复发情况,包括复发率、发作频率(OF)、发作持续时间(OST)、发作时心室率(OVR)。结果:⑴与治疗前比较,CAV、MET 2组LVEDd、LVEF均无显著变化(均P>0.05),2组SHR治疗前后分别为(68±12)次/m in,(61±9)次/m in和(69±11)次/m in,(61±11)次/m in,显著减慢(均P<0.05);CAV组LAD变化不显著(P>0.05),但MET组LAD显著升高(P<0.01);CAV组治疗前后MMP2、MMP9表达分别为(138.5±56.4)ng/d l与(103.7±49.5)ng/d l和(19.6±11.1)ng/d l与(11.3±9.4)ng/d l,显著降低(P<0.05,P<0.01),MET组MMP2、MMP9表达下降无显著性(P>0.05);CAV组OF明显下降(P<0.01),MET组OF无显著变化(P>0.05)。⑵治疗后2组比较,CAV组除LAD显著低于MET组外(P<0.01),其余心脏形态功能指标2组均无统计学差异(P<0.01,P>0.05);CAV组MMP2、MMP9表达及AF OF、OST也显著低于MET组(均P<0.05),2组AF复发率、OVR均无明显差别(均P>0.05)。⑶CAV及MET组,OF与LAD均呈正相关(r=0.826,P<0.01),与MMP2、MMP9表达也呈正相关(r=0.773,r=0.819,均P<0.01)。⑷CAV和MET 2组,均未出现严重的房室传导阻滞,2种药物对血糖未产生显著的影响。结论:CAV可安全有效地用于预防PAF复发。

Objective： To study the efficacy and safety of earvedilol for preventing recurrence of paroxysmal atrial fibrillation （PAF） in order to benefit rational and safe use of carvedilol. Methods： Fifty-three patients with PAF were enrolled in a prospective, randomized, parallel, controlled study, and assigned to two groups： the carvedilol （CAV） group （27 cases） and the metoprolol （MET）group （26 cases）. The patients in both groups received carvedilol 25 mg daily or metoprolol 50 mg daily, respectively. Duration of treatment was 1 year. MMP2 and MMP9） expressions in peripheral blood monouclear cells, silent heart rate （ SHR）, left atrial diameter （LAD） , left ventricular end-diastolic diameter （LVEDd） , and left ventricular ejection fraction （LVEF） were measured before and after treatment. Atrial fibrillation （AF） recurrence parameters including AF recurrence rate, occurrence frenqueney （OF） , occurrence sustain time （OST） and occurrence ventricular rate （OVR） were all recorded during one year of therapy. Results： （1） In comparison of after treatment with before treatment. LVEDd and LVEF found no change in the two groups （ all P 〉 0.05） ; SHR was （68 ± 12） beats/rain and （61±9） beats/rain in the CAV group, and （69 ± 11 ） beats/min and （61 ± 11 ） beats/min in the MET group, respectixely, SHR was significantly slower after treatment than before treatment （ all P 〈 0.05 ） ; there was no significant change in LAD in the CAV group （ P 〉0.05 ） , but LAD in the MET group was markedly greater （ P 〈 0.01 ） ; MMP2 and MMP9 expressions before and after teatment were （ 138.5 ± 56.4） ng/dl, （ 103.7 ± 49.5 ） ng/dl and （ 19.6 ± 11.1 ） ng/dl, （ 11.3 ± 9.4） ng/dl in the CAV group, MMP2 and MMP9） expressions were markedly lower ＇after treatment than before treatment （P 〈0.05, P 〈 0.01 ） , MMP2 and MMP9 expressions showed no significant decrease in the MET group （ P 〉 0.05）. OF decreased significantly in the CAV group （ P 〈 0. 01 ）, but there was no marked difference in the MET group （ P 〉 0.05 ）. （2） In comparison of both groups after treatment, LAD was marked lower in the CAV group than in the MET group （P 〈 0.01 ） , but there was no statistically difference in other parameters of heart morphology and function （all P 〉0.05） ; MMP2 and MMP9 expressions, OF and OST of AF were lower in the CAV group than in the MET group （ P 〈0.01, P 〈0.05） ; and there was no significant difference for AF recurrence rate and OVR in both groups （ all P 〉0.05）. （3） A positive correlation was observed between OF and LAD （r = 0. 826, P 〈 0.01 ）, and the expressions of MMP2 and MMP9 （r =0. 773, r =0. 819, all P 〈0.01 ）. （4） No severe A-V block was found in both groups. The two drugs did not influence on the blood glucose levels. Conclusion： Carvedilol could be safely and effectively used for preventing recurrence of paroxysmal atrial fibrillation.