辛伐他汀对高血压并发阵发性心房颤动的作用及机制

Study on the effect and mechanism of sinvatatin treating paroxysmal atrial fibrillation with hypertensive disease

目的:研究辛伐他汀对高血压并发阵发性心房颤动(房颤)患者房颤再发率和持续性房颤发生率的影响以及其对血高敏C反应蛋白(hsCRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及肾素、血管紧张素Ⅱ(AngⅡ)的水平的影响。方法:将87例高血压并发阵发性房颤患者随机分为2组:辛伐他汀组45例,常规治疗的同时,予口服辛伐他汀20mg/d;对照组42例,仅给予常规治疗。追踪24个月,观察2组治疗1年后阵发性房颤再发率和持续性房颤的发生率,并检测治疗前及治疗1年后hsCRP、IL-6、TNF-α、肾素、AngⅡ的表达水平。结果:辛伐他汀组房颤再次发作7例(15.6%),明显低于对照组(14例,33.4%);辛伐他汀组转为持续性房颤2例(4.5%),亦明显低于对照组(5例,11.9%);差异均有统计学意义(P<0.05)。辛伐他汀组治疗后血清hsCRP、IL-6、TNF-α、肾素、AngⅡ的水平,与对照组比较均下降,差异有统计学意义(P<0.05)。所有再发房颤患者的血清hsCRP、IL-6、TNF-α、肾素、AngⅡ水平均比未再发房颤患者的明显升高,差异有统计学意义(P<0.01)。结论:高血压并发阵发性房颤的患者应用辛伐他汀治疗,能够降低阵发性房颤的再发率,减少持续性房颤的发生率,而且降低血清hsCRP、IL-6、TNF-α、肾素、AngⅡ的水平,后者可能与房颤再发相关,提示炎症反应及肾素-血管紧张素-醛固酮系统的激活具有促进心房颤动的发生和持续的作用。

Objective：To study the effect of sinvatatin on paroxysmal atrial fibrillation with hypertensive disease,including the rate of recurrence of paroxysmal atrial fibrillation and incidence rate of persistence atrial fibrillation.Furthermore,to explore the effect of sinvatatin on high sensitive C-reactive protein （hsCRP）,IL-6,TNF-α,rennin,angiotensinⅡ （AngⅡ） and the link of between these factors and atrial fibrillation.Method：Eighty-seven patients with paroxysmal atrial fibrillation and with hypertensive disease patients were divided into two groups：Intervention group （45 cases）：beside conventional therapy,also giving 20 mg/d sinvatatin.Control group （42 cases）：only giving conventional therapy.Then tracing 24 months,detecting the level of hsCRP,IL-6,TNF-αrennin,AngⅡbefore therapy and therapy one year after and observing rate of recurrence of paroxysmal atrial fibrillation and incidence rate of persistence atrial fibrillation.All cases were followed up 24 months,the level of hsCRP,IL-6,TNF-α,rennin and AngⅡ,the rate of recurrence of paroxysmal atrial fibrillation and incidence rate of persistence atrial fibrillation were all detected before and 1 year after therapy.Result：No significant changes of hsCRP,IL-6,TNF-α,rennin,AngⅡlevels were found between the control group and intervention group before therapy,but intervention group had significantly lower levels after one year therapy compared with that in control group （P0.05）.There is significant significant ly lower rate of recurrence of paroxysmal atrial fibrillation among in intervention group （7 patients,15.6%） compared with that in control group （14 patients,33.4%）.There is significant significantly lower incidence rate of persistence atrial fibrillation among in intervention group （2 patients,4.5%） compared with that in control group （5 patients,11.9%,P0.05）.All recrudesced patients had significantly high levels of hsCRP,IL-6,TNF-α,rennin,AngⅡcompared with that in no recrudesced patients （P0.01）.Conclusion：Sinvatatin can degrade rate of recurrence of paroxysmal atrial fibrillation and incidence rate of persistence atrial fibrillation of with hypertensive disease.Furthermore,sinvatatin can degrade the serum level levels of hsCRP,IL-6,TNF-α,rennin and AngⅡ,which maybe correlated with recurrence of paroxysmal atrial fibrillation.It indicates that the inflammatory reaction and the activation of RAAS may promote the occurrence and maintenance of atrial fibrillation.