螺内酯对阵发性心房颤动发作的影响

Effect of spironolactone on paroxysmal atrial fibrillation

目的观察螺内酯对阵发性心房颤动(AF)的抑制作用及对心房结构和功能重构的影响。方法选择因Ⅲ度房室传导阻滞植入双腔起搏器的阵发性AF患者96例,分为两组,治疗组(48例)给予螺内酯20 mg/d,对照组(48例)不予螺内酯治疗。随访12个月,观察研究前后血浆醛固酮(Ald)浓度、AF发作情况、左房结构和功能变化。结果治疗组应用螺内酯12个月后Ald水平较前明显降低(5.30 ng/dl vs 7.70 ng/dl,P<0.01),AF发作次数及AF负荷明显减少,左房内径、左房最大容积、左房最小容积及左房收缩期前容积均减小,左房射血分数增高(P均<0.01)。与对照组相比,上述指标亦有显著差异(P均<0.05)。结论醛固酮受体拮抗剂——螺内酯能够抑制阵发性AF患者心房结构和功能的改变,减少AF发生率及持续时间。

Objective To observe the effect of spironolactone on preventing paroxysmal atrial fibrillation （AF） and left atrial remodeling and function in patients with dual-chamber pacemaker implantation because of third degree atrioventricular block. Methods Ninety-six eligible patients were divided into two groups. The treatment group （n = 48）were given spironolaetone , 20 rag/d; the control group（ n = 48） were not given any aldosterone（Ald） receptor antagonists. After 12-month follow-up, the plasma Ald, AF times, AF burden, left atrial structure and function were observed and compared before and after study. Results After 12-month follow-up, plasma Ald was significantly lower（ 5.30 ng/dl vs 7.70 ng/dl, P 〈 0. 01 ） ; AF times and AF burden were significantly decreased; Left atrial diameter, the maximum left atrial volume, the mini- mum left atrial volume and left atrial volume before systole were significantly reduced; Left atrial ejection fraction was significantly increased compared to baseline level in the treatment group（ P 〈0. 01 ）. And there were significant differences in the above-mentioned indicators between the two groups at the end of study（ P 〈 0.05 ）. Conclusion Spironolactone can attenuate atrial remodeling, improve atrial function, and reduce AF incidence and AF burden in patients with paroxysmal AF.