厄贝沙坦联合胺碘酮治疗心力衰竭合并房颤的疗效及其对心功能、血浆Ang-Ⅱ、NE及BNP水平的影响

Therapeutic effects of irbesartan combined amiodarone on heart failure patients with atrial fibrillation and its influence on cardiac function,plasma levels of Ang-Ⅱ,NE and BNP

目的:研究厄贝沙坦联合胺碘酮治疗心力衰竭(HF)合并房颤(AF)的疗效及其对心功能、血浆血管紧张素Ⅱ(Ang-Ⅱ)、去甲肾上腺素(NE)及B型脑钠肽(BNP)水平的影响。方法:2016年9月~2017年9月于我院就诊的HF合并AF患者98例被随机分为胺碘酮组(在常规治疗基础上加用胺碘酮,49例)和联合治疗组(在胺碘酮组基础上加用厄贝沙坦,49例)。两组均治疗6个月。观察比较两组治疗前后心率、血压、心功能指标、血浆Ang-Ⅱ、NE、BNP水平,以及不良反应发生情况。结果:与治疗前比较,治疗后两组心率、血压、左室舒张末期面积(LVEDd)、左室收缩末期面积(LVESd)、血浆Ang-Ⅱ、NE及BNP水平显著下降,左室射血分数(LVEF)显著升高,P<0.05或<0.01。与胺碘酮组比较,联合治疗组治疗后心率[(95.6±13.7)次/min比(81.4±11.8)次/min]、血压[(145.7±20.6)/(89.1±11.4)mmHg比(132.3±17.5)/(81.3±10.2)mmHg]、LVEDd[(58.3±5.2)mm比(53.2±4.6)mm]、LVESd[(44.2±5.1)mm比(38.1±4.9)mm]、血浆Ang-Ⅱ[(113.27±10.14)pg/ml比(98.67±8.79)pg/ml]、NE[(1.90±0.31)pg/ml比(1.74±0.28)pg/ml]、BNP[(282.18±54.16)pg/ml比(214.36±41.25)pg/ml]水平降低更显著,LVEF[(39.8±4.1)%比(48.6±5.5)%]升高更显著,P均<0.01。两组治疗不良反应发生率无显著差异,P=0.712。结论:厄贝沙坦联合胺碘酮治疗HF合并AF可有效改善患者心功能,降低心率、血压、血浆Ang-Ⅱ、NE及BNP水平,且安全性好。

Objective:To study therapeutic effects of irbesartan combined amiodarone on heart failure(HF)patients with atrial fibrillation(AF)and its influence on cardiac function,plasma levels of Ang-Ⅱ,NE and BNP.Methods:A total of 98 HF patients with AF treated in our hospital from Sep 2016 to Sep 2017 were randomly divided into amiodarone group(received amiodarone based on routine treatment)and combined treatment group(received irbesartan based on amiodarone group).Both group were treated for six months.HR,BP,cardiac function indexes,plasma levels of Ang-Ⅱ,NE and BNP before and after treatment,and incidence of adverse reactions were observed and compared between two groups.Results:Compared with before treatment,after treatment,there were significant reductions in HR,BP,LVEDd,LVESd,plasma levels of Ang-Ⅱ,NE and BNP,and significant rise in LVEF in two groups,P<0.05 or<0.01.Compared with amiodarone group,after treatment,there were significant reductions in HR[(95.6±13.7)beats/min vs.(81.4±11.8)beats/min],BP[(145.7±20.6)/(89.1±11.4)mmHg vs.(132.3±17.5)/(81.3±10.2)mmHg],LVEDd[(58.3±5.2)mm vs.(53.2±4.6)mm],LVESd[(44.2±5.1)mm vs.(38.1±4.9)mm],plasma levels of Ang-Ⅱ[(113.27±10.14)pg/ml vs.(98.67±8.79)pg/ml],NE[(1.90±0.31)pg/ml vs.(1.74±0.28)pg/ml]and BNP[(282.18±54.16)pg/ml vs.(214.36±41.25)pg/ml],and significant rise in LVEF[(39.8±4.1)%vs.(48.6±5.5)%]in irbesartan group,P<0.01 all.There was no significant difference in incidence rate of adverse reactions during treatment between two groups,P=0.712.Conclusion:Irbesartan combined amiodarone can effectively improve cardiac function,reduce HR,BP,plasma levels of Ang-Ⅱ,NE and BNP with good safety in HF patients with AF.