阿托伐他汀对植入双腔心脏起搏器的病态窦房结综合征患者左心室重构的影响

Influence of atorvastatin on left ventricular remodeling in patients with sick sinus syndrome undergoing dual-chamber pacemaker implantation

目的:探讨阿托伐他汀对植入双腔心脏起搏器(DDD)的病态窦房结综合征(SSS)患者左心室重构的影响。方法:选择在本院心血管内科住院并行DDD植入术的SSS患者108例为研究对象,随机分为常规治疗组(54例,起搏器植入后给予常规抗心律失常药物治疗)和阿托伐他汀组(54例,在常规治疗基础上给予阿托伐他汀治疗)。6个月后,比较两组手术前后左心室重塑指标、心功能指标、心房高频事件(AHREs)发作次数、AHREs持续时间等变化,同时记录治疗期间不良反应。结果:术后6个月,与常规治疗组比较,阿托伐他汀组左室射血分数(LVEF)[(63.91±5.12)%比(65.84±4.85)%]显著提高,LVEDd[(44.26±4.05)mm比(42.48±3.84)mm]和LVESd[(30.89±3.17)mm比(29.31±2.84)mm]显著减小(P<0.05或<0.01);血浆BNP[(127.84±30.84)pg/ml比(98.18±25.95)pg/ml]和NT-proBNP[(313.57±61.56)pg/ml比(269.46±54.48)pg/ml]水平显著降低(P均=0.001);AHREs发作次数[(285.38±45.54)次/年比(263.36±51.28)次/年]和AHREs时间[(17.32±7.54)h/年比(12.74±7.32)h/年]均显著减少(P<0.05或<0.01)。两组治疗期间均未出现肌溶解、转氨酶显著升高(3倍以上)等不良反应。结论:阿托伐他汀可逆转双腔心脏起搏器植入术后病态窦房结综合征患者左心室重构,提高心功能,减少术后心房颤动的发生,且安全性高。

Objective:To explore influence of atorvastatin on left ventricular remodeling in patients with sick sinus syndrome(SSS)undergoing dual-chamber pacemaker(DDD)implantation.Methods:A total of 108 SSS patients,who were hospitalized in our department and underwent DDD implantation,were randomly and equally divided into routine treatment group(received routine anti-arrhythmia medication after DDD implantation)and atorvastatin group(received atorvastatin based on routine treatment group).After six-month treatment,left ventricular remodeling indexes,cardiac function indexes,onset times of atrial high rate episodes(AHREs)and AHREs duration before and after operation were compared between two groups,and incidence of adverse reactions during treatment was recorded.Results:Compared with routine treatment group six months after operation,there was significant rise in LVEF[(63.91±5.12)%vs.(65.84±4.85)%],and significant reductions in LVEDd[(44.26±4.05)mm vs.(42.48±3.84)mm]and LVESd[(30.89±3.17)mm vs.(29.31±2.84)mm],P<0.05 or<0.01;significant reductions in plasma levels of BNP[(127.84±30.84)pg/ml vs.(98.18±25.95)pg/ml]and NT-proBNP[(313.57±61.56)pg/ml vs.(269.46±54.48)pg/ml],P=0.001 both;and significant reductions in onset times of AHREs[(285.38±45.54)times/year vs.(263.36±51.28)times/year]and AHREs duration[(17.32±7.54)h/year vs.(12.74±7.32)h/year]in atorvastatin group,P<0.05 or<0.01.During treatment period,no myolysis and significant transaminase rise(>three times)occurred in either group.Conclusion:Atorvastatin can reverse left ventricular remodeling in SSS patients after DDD implantation.It can improve cardiac function and reduce the occurrence of postoperative atrial fibrillation with high safety.