炙甘草汤联合胺碘酮治疗阵发性心房颤动及对心房重构的影响

Effect of Zhigancao decoction combined with amiodarone on paroxysmal atrial fibrillation and atrial remodeling

目的观察炙甘草汤联合胺碘酮治疗阵发性房颤的临床疗效,并探究其对心房重构的影响。方法采用平行、随机、对照试验方案,选择符合阵发性房颤(气阴两虚证)诊断标准患者60例,随机分为治疗组和对照组各30例,给予基础治疗的同时,治疗组给予炙甘草汤联合胺碘酮治疗,对照组单用胺碘酮治疗,疗程4周。治疗前、后记录每例患者的临床症状、房颤发作次数及持续时间,测量最大P波时限及P波离散度,测定高敏C反应蛋白、N末端B型利钠肽前体、醛固酮水平变化情况。记录治疗前后三大常规、肝、肾功能等安全性指标与不良反应事件。结果治疗组总有效率为90.00%,对照组为70.00%,治疗组优于对照组(P<0.05)。两组患者Pmax及Pd均较治疗前缩短,且治疗组改善更显著(P<0.05)。治疗组患者hs-CRP、NT-pro BNP、Ald水平均较治疗前下降,对照组NT-pro BNP及Ald水平较治疗前下降,差异有统计学意义(P<0.05)。两组不良反应情况比较,无统计学差异(P>0.05)。结论炙甘草汤联合胺碘酮治疗阵发性房颤有效减少房颤发作次数及持续时间,其作用机制可能通过缩短Pd及Pmax、降低hs-CRP、BNP、Ald水平从而抑制心房重构。

Objective To observe the clinical efficacy of Zhigancao decoction combined with amiodarone in the treatment of paroxysmal atrial fibrillation andto explore its effect on atrial remodeling. Methods A total of 60 patients with paroxysmalatrial fibrillation（Qi and Yin Deficiency） were selected according to parallel, randomized, controlled trial protocol randomly and divided into treatment group and control group, with 30 cases in each group. The patients in both groups were given the basic treatment. The treatment group was given Zhigancao decoction combined with amiodarone treatment at the same time, while the control group was treated with amiodarone alone for 4 weeks. The clinical symptoms, the number and duration of atrial fibrillation of each patient before and after treatment were recorded. The maximum P wave duration and P wave dispersion were measured. The changes of the levels of high sensitivity C-reactive protein, N-terminal B-type natriuretic peptide and aldosterone were measured. The safety parameters and adverse events were recorded before and after treatment. The three routine examinations, safety indicators including liver and kidney function and adverse events before and after treatment were recorded. Results The total effective rate（90.00%） in the treatment group was better than 70.00% in the control group （P〈0.05）. Pmax and Pd in both groups were shorter than those before treatment, and the improvement was more significant in the treatment group（P〈0.05）. The levels of hs-CRP, NT-proBNP and Aid in the treatment group were lower than those before treatment, and the levels of NT- proBNP and Ald in the control group were significantly lower than those before treatment, and the difference was statistically significant （P〈0.05）. AdVerse reaction of two groups had no statistical difference（P〉0.05）. Conclusion Zhigancao decoction＇combined with amiodarone in the treatment of paroxysmal atrial fibrillation can effectively reduce the number and duration of atrial fibrillation. The mechanism may be by shortening the Pd and Pmax, and reducing hs- CRP, BNP, Aid levels to inhibit atrial remodeling.