螺内酯对老年心房颤动患者血清Ⅰ型胶原代谢的影响

Effects of spironolactone on serum markers of collagen metabolism type Ⅰ in elderly patients with atrial fibrillation

目的通过测定老年心房颤动(房颤)患者使用螺内酯治疗前后血清醛固酮、Ⅰ型前胶原羧基端肽(PICP)及Ⅰ型胶原羧基端交联肽(CITP)水平的变化,探讨螺内酯减轻心房纤维化的可能机制。方法选择房颤患者67例和条件相匹配的窦性心律患者30例,并将房颤患者随机分为常规治疗组(33例)及螺内酯(20mg/d)治疗组(34例),治疗6个月,用放射免疫法测定治疗前后血清醛固酮、PICP及CITP水平。另选对照组为30例,无房颤发作史,心电图及24小时动态心电图为窦性心律,一般资料匹配。结果房颤组血清PICP、CITP、醛固酮浓度及左房大小均显著高于对照组(P<0.01)。房颤组血清醛固酮与左房大小呈正相关(r=0.302,P<0.05)、血清PICP浓度与左房大小呈正相关(r=0.369,P<0.01),螺内酯治疗组与常规治疗组治疗后血清醛固酮、PICP水平与治疗前相比均下降,但螺内酯治疗组下降更明显,治疗后两组血清醛固酮及PICP水平比较差异具有统计学意义(P<0.01)。结论螺内酯通过降低房颤患者血清醛固酮、PICP水平,从而减轻心房纤维化,延缓房颤的发生发展。

Objective To investigate the effects of spironolactone on the serum levels of aldosterone,carboxy-terminal peptide of procollagen type Ⅰ（PICP） and carboxy-terminal telopeptide of collagen type Ⅰ（CITP） before and after treatment in elderly patients with atrial fibrillation and explore its possible mechanism of reducing myocardial fibrosis.Methods Sixty-seven elderly patients with atrial fibrillation were divided randomly into two groups：34 cases of spironolactone treatment group and 33 cases of routine treatment group.The patients in spironolactone group were treated by spironolactone 20 mg/day for six months.Serum levels of aldosterone,PICP and CITP were measured at baseline and at the end of six months in 67 elderly patients with atrial fibrillation and 30 control subjects by radioimmunoassay.Another 30 cases matched in general conditions without atrial fibrllation and with normal ECG servedas control group.Results The serum level of PICP,CITP,aldosterone and left atrial dimension remarkably were higher in patients with atrial fibrillation than those in the control subjects（P0.01）.There was positive correlation between serum levels of aldosterone,PICP and left atrial dimension in patients with atrial fibrillation（r=0.302,P0.05,r=0.369,P0.01）.The serum level of aldosterone and PICP after treatment in spironolactone group was lower than that in routine treatment group（P0.01）.Conclusion Spironolactone may alleviate myocardial fibrosis by decreasing serum levels of aldosterone and PICP,postpone occurrence and progress of atrial fibrillation.