替米沙坦预防高血压伴阵发性心房颤动的临床研究

Clinical research of telmisartan in preventing hypertension with paroxysmal atrial fibrillation

目的：观察替米沙坦预防高血压伴阵发性心房颤动复发的效果，并探讨替米沙坦预防房颤复发的量效关系及其主要机制。方法将符合入选条件的186例患者采用数字表法随机分为观察组（n ＝91）和对照组（n ＝95）。观察组又用数字表法随机分为替米沙坦20 mg 组（n ＝30）、40 mg 组（n ＝30）、80 mg 组（n ＝31）3个观察亚组。各组均给予标准剂量的胺碘酮，各观察亚组口服相应剂量的替米沙坦，对照组避免应用肾素-血管紧张素系统抑制剂。随访6个月，观察各组患者的血压、左室舒张末内径（LVEDD）、左房内径（LAD）的变化，统计房颤复发例数、次数以及房颤首次复发时间。结果观察组、替米沙坦80 mg 组在6个月内房颤复发例数（分别为26例、6例）与次数[分别为（0．35±0．08）次、（0．34±0．07）次]显著减少（χ2＝5．413、5．0262，P ＜0．05；u ＝11．111，t ＝9．668，P ＜0．01）。替米沙坦40 mg 组房颤首次复发时间在6个月内[（97．87±30．42）d]明显延长（t ＝2．175，P ＜0．05），80 mg 组[（102．36±31．53）d]更为显著（t ＝2．930，P ＜0．01）。同时，6个月内观察组 LVEDD[（48．39±2．65）mm]、LAD[（34．47±2．18）mm]和替米沙坦80 mg 组LAD[（34．04±2．13）mm]显著缩短[u ＝2．019（LVEDD）、u ＝2．143（LAD），t ＝2．3785，P ＜0．05）]。结论替米沙坦对预防高血压伴阵发性房颤的复发有效，且存在量效关系，其机制主要与抑制心房结构重构有关。

Objective To observe the effects of telmisartan（Tel）in the recurrence prevention of hyperten-sion with paroxysmal atrial fibrillation（PAF）,and to explore the dose -effect relationship and the main mechanism of Tel in the prevention of atrial fibrillation（AF）.Methods 186 cases who met the inclusion criteria were randomly divided into the observation group（n =91）and the control group（n =95）.And the observation group was randomly divided into the 20 mg subgroup（n =30）,40 mg subgroup（n =30）and 80 mg subgroup（n =31）.The standard dose of amiodarone（Ami）was uniformly administered to each group,and the observation subgroups were orally adminis-tered the scheduled doses of Tel,while the control group avoided the application of the renin -angiotensin system inhibitors.The follow -up lasted for 6 months,the changes of blood pressure,the recurrence number and frequency of AF,and the first recurrence time,the left ventricular end -diastolic diameter（LVEDD）and the left atrial diameter （LAD） were observed.Results The recurrence number （26cases,6cases respectively） and frequency of AF [（0.35 ±0.08）times,（0.34 ±0.07 ）times respectively]in the observation group and the 80 mg subgroup in 6 months significantly reduced（χ2 =5.413,5.026,all P 〈0.05 and u =11.111,t =9.668,all P 〈0.01）.The first recurrence time of AF in the 40 mg subgroup was significantly longer within 6 months[（97.87 ±30.42）d]（t =2.175,P 〈0.05）,which was much more significant than that in the 80 mg subgroup[（102.36 ±31.53）d]（t =2.930,P 〈0.01）.Meanwhile,the LVEDD[（48.39 ±2.65）mm]and LAD[（34.47 ±2.18）mm]in the observation group and the LAD[（34.04 ±2.13）mm]in the 80mg subgroup within 6 month were significantly shorter[u =2.019 （LVEDD）,u =2.143（LAD）and t =2.378,all P 〈0.05].Conclusion Tel was effective in the recurrence preven-tion of hypertension with PAF,existed a dose -effect relationship,which was mainly related with the inhibition of atrial structural remodeling.