培哚普利联合醛固醇受体拮抗剂对心房纤颤犬心房结构重构的影响

The effects of Perindopril plus Spironolactone on atrial structural remodeling in chronic rapid atrial pacing dogs

目的:观察培哚普利和螺内酯及二者联用对长期心房快速起搏诱发心房纤颤(房颤,AF)犬心房结构和功能重构的影响。方法:实验犬24只,随机分为4组,即对照组、培哚普利组(P组)、螺内酯组(S组)和二者联用组(P+S组)。各组心房快速起搏8周,建立AF犬模型。分别于起搏前、起搏4周及8周测定血浆血管紧张素II(AngII)和醛固酮(Ald)水平;起搏前及起搏后8周,测定左心房结构和功能变化;起搏8周后停止起搏,观察各组犬AF维持的例数及AF自行持续时间;Masson染色检测各组犬心房肌胶原容积分数(CVF)改变。结果:与对照组相比,P组、S组和P+S组犬起搏4周和8周后血浆AngII及Ald水平明显降低,起搏8周后左心房左右径、上下径、收缩末期容积和舒张末期容积明显减小,左心房射血分数显著增大,停止起搏后AF维持率明显减少,AF平均持续时间明显缩短,CVF值明显降低。而3个用药组相比差异无统计学意义。结论:培哚普利和醛固酮受体拮抗剂(螺内酯)能够阻止长期心房快速起搏AF犬心房结构功能的改变及心房纤维化,减少AF发生率及持续时间,但二者联用效果并不优于单药。

Objective：To investigate the effects of Perindopril plus Spironolactone on atrial structural and functional remodeling in atrial fibrillation（AF） dogs induced by chronic rapid atrial pacing.Methods：Twenty-four dogs were paced for 8 weeks and randomly divided into four groups：control group,Perindopril group（P）,Spironolactone group（S）,and combination of Perindopril and spironolactone group（P ＋ S）.Plasma angiotensinⅡ（AngⅡ） and aldosterone（Ald） were measured before and after 4 and 8weeks pacing.The form and function of left atrial before and after 8 weeks pacing were measured by echocardiography.The number of dogs maintaining AF and duration of AF after stopping of pacing were recorded.Atrial collagen volume fraction（CVF） was analyzed by Masson staining.Results：Compared with the control group,plasma Ang Ⅱand Ald after 4 and 8 weeks pacing in P group,S group and P ＋ S group were significantly lower;after 8 weeks pacing,the diameter,end-systolic volume and end-diastolic volume of the left atrium of P group,S group and P ＋ S group were significantly smaller,and left atrial ejection fraction was higher;the number of dogs maintained atrial fibrillation of three drug treatment groups after stopping of pacing was significantly reduced,average duration of AF was shorter;and the value of CVF in P group,S group and P ＋ S group was significantly lower.There was no significant differences between three drug treatment groups.Conclusion：Perindopril and aldosternone receptor antagonists（Spironolactone） improved the changes of atrial structure and function,prevent atrialfibrosis and reduce the incidence and duration of atrial fibrillation in the atrial fibrillation dogs induced by chronic rapid atrial pacing.And the effects of two drugs combining therapy were not superior to monotherapy.