缬沙坦联合瑞舒伐他汀治疗非瓣膜性阵发性心房颤动复律后维持窦性心律40例

Effect of Valsartan Combined with Rosuvastatin on Maintenance of Sinus Rhythm in 40 Cases with Non Valvular Paroxysmal Atrial Fibrillation After Cardioversion

目的观察缬沙坦联合瑞舒伐他汀对非瓣膜性阵发性心房颤动(PAF)患者复律后维持窦性心律的疗效。方法选择经胺碘酮转复为窦性心律的PAF患者120例,按照维持窦性心律用药的不同,随机分为A组(40例)单用胺碘酮;B组(40例)应用(缬沙坦+瑞舒伐他汀);C组(40例)应用(缬沙坦+瑞舒伐他汀+胺碘酮),比较3组患者治疗前及治疗12个月后P波最大时限(Pmax)、P波离散度(Pwd)、左心房内径(LADd)的变化,及PAF复律后3,6,12个月内窦性心律维持率,记录3组患者12个月内药物的不良反应。结果 B组的不良反应发生率低于A组和C组(B组比A组,χ~2=7.314,P=0.007;B组比C组,χ~2=6.135,P=0.013)。A组与C组的不良反应发生率比较(χ~2=0.075,P=0.785),差异无统计学意义;C组的hs-CRP、Pmax、Pwd、LADd低于A组(均P<0.05),LVEF高于A组(P<0.05)。B组的hs-CRP、Pmax、Pwd、LADd低于A组(均P<0.05),两组的LVEF比较差异无统计学意义(P=0.032)。C组的Pmax低于B组(P=0.012),LVEF高于B组(P=0.002),两组的hs-CRP、Pwd、LADd比较差异无统计学意义。治疗12个月后,C组的窦性心律维持率高于A组与B组(C组比A组,χ~2=6.134,P=0.013;C组比B组,χ~2=9.869,P=0.002)。A组与B组的窦性心律维持率比较(χ~2=0.446,P=0.504),差异无统计学意义。结论对非瓣膜性PAF患者复律后维持窦性心律,C组疗效最好,B组和A组疗效相当,但B组不良反应比A组和C组较少,B组和C组方案可有效抗炎、抑制心房重构。

Objective To study the effect of valsartan combined with rosuvastatin on maintenance of sinus rhythm in patients with non valvular paroxysmal atrial fibrillation after cardioversion（ PAF）. Methods Totally,120 patients with PAF who converted into sinus rhythm by amiodarone were randomly assigned to three groups in accordance with the maintenance of sinus rhythm of different drugs： group A（ 40 cases）,amiodarone alone; group B（ 40 cases）,valsartan＋rosuvastatin; group C（ 40 cases）,valsartan＋rosuvastatin＋amiodarone.The changes in P wave maximum duration（ Pmax）,P wave dispersion（ Pwd）,and left atrial diameter（ LADd） were compared among the three groups before treatment and 12 months after the treatment; the maintenance rate of sinus rhythm 3,6,and 12 months after cardioversion was compared; adverse drug reactions of the three groups within12 months were recorded. Results The incidence of adverse reactions was lower in group B than in group A and group C（ group B vs. group A,χ^2= 7. 314,P = 0. 007; group B vs. group C,χ^2= 6. 135,P = 0. 013）. There was no significant difference in the incidence of adverse reactions between group A and group C（ χ^2= 0.075,P = 0.785）; Hs-CRP,Pmax,Pwd,LADd in group C was lower than those in group A（ all P〈0.05）,LVEF in group C was higher than that in group A（ P〈0.05）,hs-CRP,Pmax,Pwd,LADd were lower in group B than in group A（ all P〈0. 05）. There were no statistically significant differences in LVEF between the two groups（ P = 0. 032）. Pmaxwas lower in group C than in group B（ P = 0. 012）,LVEF was higher in group C than in group B（ P = 0.002）.There were no statistically significant differences of hs-CRP,Pwd,LADd between the two groups.After 12 months of treatment,the maintenance rate of sinus rhythm in group C was higher than that in group A and group B（ group C vs.group A,χ^2= 6. 134,P = 0. 013; group C vs. group B,χ^2= 9. 869,P = 0. 002）. There was no statistically significant difference in sinus rhythm maintenance rate between group A and group B（ χ^2= 0.446,P = 0.504）. Conclusion For sinus rhythm maintenance in patients with nonvalvular atrial fibrillation after cardioversion,the efficacy of group C is the best,group B and group A showed similar efficacy,but the incidence of adverse reactions of group B was less than that of group A and group C. Group B and group C have anti-inflammatory effect and inhibit atrial remodeling.