依那普利对阵发性心房颤动患者心房利钠肽和心房重构的影响

Effect of Enalapril on the Atrial Natriuretic Peptide and Atrial Remodeling in Patients with Paroxysmal Atrial Fibrillation

目的 探讨依那普利对阵发性心房颤动（PAF）患者心房利钠肽（ANP）和心房重构的影响.方法 PAF患者91例,分为对照组55例,治疗组36例.所有患者在常规治疗基础上,均给予胺碘酮200 mg,tid,po,5～7 d后减为200 mg,bid,再连续服用5～7 d后减为200 mg,每日或隔日1次维持服用.治疗组加用依那普利10 mg,qd,如发生低血压则改为5 mg,qd.观察患者在治疗前、治疗3和6个月时的ANP水平和心脏超声参数[左心房直径（LAD）、左心室舒张末内径（LVEDD）和左心房容积最大值（LAVmax）]及心房颤动复发率的变化.结果治疗组和对照组治疗3个月时ANP分别为（159.8±67.9）,（171.5±74.7） pg·mL-1（P＜0.05）,LAVmax分别为（85.6±27.8）,（96.9±26.4） mL·（m2）-1（P＜0.05）;治疗6个月时ANP分别为（143.6±57.4）,（174.1±63.5） pg·mL-1 （P＜0.01）,LAVmax分别为（93.3±24.7）,（108.7±28.0） mL·（m2）-1（P＜0.05）,LAD分别为（34.6±4.9）,（40.5±4.6） mm（P＜0.01）;治疗3个月时心房颤动复发率分别为16.7%,32.7%;治疗6个月时心房颤动患者ANP水平,改善心房重构,减少心房颤动复发.复发率分别为38.9%,60.0%（P＜0.05）.

Objective To explore effects of enalapril on atrial natriuretic peptide （ANP） and atrial remodeling in patients with paroxysmal atrial fibrillation （PAF）. Methods A total of 91 PAF patients were divided into control （n = 55 ） and treatment （n= 36） groups. All the patients received conventional treatment and amiodarone 200 mg rid for 5-7 days, with a dose reduction to 200 mg bid for another 5-7 days, followed by a maintenance dose of 200 mg daily or every other day. Enalapril 10 mg daily was added for patients in the treatment group, with a dose reduction to 5 nag daily in case of hypotension. The changes in the plasma level of ANP and ultrasonic parameters such as left atrial diameter （ LAD ） , left ventricular end-diastolic dimension （LVEDD） and left atrial volume at the largest area （LAVmax） at the baseline and after 3 and 6 months of follow-up were observed. Furthermore, the alteration in the reoccurrence of atrial fibrillation after 3 and 6 months of follow-up was also examined. Results Compared with the controls, the plasma level of ANP[ （159.8±67.9） versus （ 171. 5±74. 7 ） pg · mL-1 at 3 months, （143.6±57.4） versus （174.1±63.5） pg · mL-1 at 6 months; P〈0.01 ] and LAVmax [ （85.6±27.8） versus （96.9±26.4） mL· （m2）-1 at3 months, （93.3±24.7） versus （108.7±28.0） mL· （mE）-1 at6 months; P〈0.05] after the treatment of enalapril were significantly decreased, so did the LAD at 6 months after the treatment of enalapril [ （34.6±4.9） versus （40.5±4.6） ram, P〈0.05 ） ]. There were no significant differences in LAD after 3 months of follow-up and LVEDD after either 3 or 6 months of follow-up. The patients with PAF in the enalapril group had significantly fewer reoccurrence rate compared to the control group （0.17 versus 0.39 at 3 months; 0.33 versus 0.60 at 6 months, P〈0.05 ）. Conclusion Enalapril can decrease the plasma level of ANP, improve left atrial remodeling and prevent the reoccurrence of atrial fibrillation in patients with PAF.