阿托伐他汀联合缬沙坦对射血分数保留慢性心衰合并阵发性房颤的疗效

Influences of atorvastatin combined with valsartan on the curative effect and prognosis in heart failure with preserved ejection fraction and atrial fibrillation patients

目的探讨阿托伐他汀联合缬沙坦对射血分数保留慢性心衰(HFPEF)合并阵发性房颤(PAF)的疗效及对预后的影响。方法选取HFPEF合并PAF患者160例,随机分为对照组与观察组,各80例。2组患者均实施常规抗心衰等治疗,对照组患者在常规抗心衰治疗基础上给予缬沙坦80mg·d-1,观察组在对照组治疗的基础上加用阿托伐他汀20mg·d-1,疗程均为1年。比较2组治疗前后血浆超敏C反应蛋白(hs-CRP)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、N端前体脑钠肽(NT-proBNP)、左心室舒张末内径(LVEDD)、左心室后壁舒张末厚度(LVPwT)和左心室射血分数(LVEF)及P波离散度。随访出院后1年内阵发性房颤(PAF)复发率、PAF转为持续性或永久性房颤例数及心脑血管不良事件发生情况。结果 (1)2组治疗前hs-CRP水平无明显差异(P>0.05)。观察组治疗后hs-CRP水平较治疗前及对照组同期均明显降低(P<0.05),而对照组治疗前后无明显变化(P>0.05)。(2)2组治疗前TC、LDL-C和HDL-C水平均无明显差异(P>0.05)。观察组治疗后TC和LDL-C水平较治疗前和对照组明显下降、HDL-C明显升高(P<0.05);而对照组治疗前后TC、LDL-C和HDL-C水平均无明显变化(P>0.05)。(3)与治疗前比较,2组治疗后LVEDD和LVPWT无明显变化(P>0.05),但LVEF明显升高(P<0.05),NT-proBNP及P波离散度明显下降(P<0.05),且观察组改善程度优于对照组(P<0.05)。(4)观察组出院后随访1年内PAF复发率、心衰再入院率明显低于对照组,差异有统计学意义(P<0.05)。结论阿托伐他汀联合缬沙坦治疗可显著降低HFPEF合并PAF患者的PAF复发率及心衰再入院率。

Objective To study the influences of atorvastatin combined with valsartan on curative effect and prognosis in patients with heart failure with preserved ejection fraction （HFPEF） complicating permanent atrial fibrillation （PAF）. Methods 160 cases of patients with HFPEF complicating PAF were were divided randomly into 2 groups：control group （ n =80） and observation group （ n =80）.The patients in the 2 groups were treated with conventional medication of anti-heart failure,and the patients in control group were added to valsartan 80 mg·d -1 on the basis of conventional medication of anti-heart failure,and the patients in observation group received additional atorvastatin 20 mg·d -1 on the basis of control group.The patients in the 2 groups were treated for one year.Hypersensitive C-reactive protein （hs-CRP）,total cholesterol （TC）,low-density lipoprotein cholesterol （LDL-C）,high-density lipoprotein cholesterol （HDL-C）, N -terminal brain natriuretic peptide （NT-proBNP）,left ventricular diastolic diameter （LVEDD）,posterior left ventricular posterior wall diastolic thickness （LVPwT）,left ventricular ejection fraction （LVEF） and P wave dispersion before and after treatment were observed and compared in both groups.PAF recurrence rates,PAF transition to persistent or permanent atrial fibrillation,cardiac vascular adverse events within one year after discharge were followed up. Results ①There was no significant difference in hs-CRP levels before treatment between the 2 groups （ P 〉0.05）.The hs-CRP levels after treatment in observation group were lower than those before treatment and in control group （ P 〈0.05）,and there was no significant change before and after treatment in the control group （ P 〉0.05）.②There was no significant difference in TC,LDL-C and HDL-C before treatment between the 2 groups （ P 〉0.05）.After treatment,TC and LDL-C were significantly decreased and HDL-C significantly increased in observation group （ P 〈0.05） and no significant change was observed in control group （ P 〉0.05）.③Compared with those before treatment,LVEDD and LVPWT showed no significant changes （ P 〉0.05）,but LVEF increased significantly （ P 〈0.05）,NT-proBNP and P wave dispersion ratio decreased obviously （ P 〈0.05） after treatment in the 2 groups,and the improved degrees in observation group were better than those in control group （ P 〈0.05）.④PAF recurrence rate,re-admission rate of heart failure within one year after discharge in observation group were lower significantly than those in control group,the differences were statistically significant （ P 〈0.05）. Conclusion Atorvastatin combined with valsartan could reduce significantly PAF recurrence rate,re-admission rate of heart failure in HFPEF patients with PAF.