依那普利叶酸片补充干预对同型半胱氨酸升高的高血压伴阵发性房颤的影响

Effects of enalapril and folic acid tablets on hypertension patients with hyperhomocysteinemia and paroxysmal atrial fibrillation

目的观察依那普利叶酸片对同型半胱氨酸(homocysteine,Hcy)升高的高血压伴阵发性房颤患者的影响,为临床诊疗提供依据。方法选取Hcy升高的高血压伴阵发性房颤患者108例,随机分为3组,每组36例,分别接受氨氯地平、依那普利或依那普利叶酸片治疗12个月后评定疗效。检测3组患者治疗前后血压、Hcy、左心房内径(left atrial diameter,LAD)、左心房功能指数(left atrial function index,LAFI)、左心房容积指数(left atrial volume index,LAVI)、舒张期总应变(global diastolic strain,Sg)、收缩期应变率(systolic strain rate,SRs)、舒张期应变率达峰时间标准差(standard deviations of time to peak global diastolic strain rate,TPSRg-SD)、收缩期应变率达峰时间标准差(standard deviations of time to peak of systolic strain rate,TPSRs-SD)等水平。结果108例患者中有106例完成本次研究。氨氯地平、依那普利或依那普利叶酸治疗后,3组患者房颤月平均发作次数显著下降,差异有统计学意义(P<0.01),且依那普利叶酸组补充干预效果更佳。与氨氯地平组相比,依那普利组及依那普利叶酸组患者LAD、NT-proBNP水平明显下降(P<0.01)。依那普利叶酸组患者的Hcy、LAVI、TPSRg-SD、TPSRs-SD指标小于依那普利组及氨氯地平组,而LAFI及Sg、SRs大于依那普利组及氨氯地平组,差异有统计学意义(P<0.05)。各组均无心功能障碍、中风或死亡患者。结论依那普利叶酸片可减少Hcy升高的高血压伴阵发性房颤患者的房颤发作频率,可能与其抑制心房重塑的机制有关。

Objective To observe the clinical effects of enalapril and folic acid tablets on hypertension patients with high homocysteine(Hcy)level and paroxysmal atrial fibrillation,so as to provide evidence for diagnosis and treatment.Methods A total of 108 hypertension patients with high Hcy level and paroxysmal atrial fibrillation were randomly divided into three groups(n=36),and treated with amlodipine,enalapril or enalapril folic acid tablets for 12 months.Their blood pressure,Hcy,left atrial diameter(LAD),left atrial function index(LAFI),left atrial volume index(LAVI),diastolic global diastolic strain(Sg),systolic strain rate(SRs),standard deviations of time to peak global diastolic strain rate(TPSRg-SD),and standard deviations of time to peak global diastolic strain rate(TPSRg-SD)before and after treatment were detected.Results There were 106 out of 108 patients who finished the study.After treatment with amlodipine,enalapril or enalapril and folic acid,the occurrence of atrial fibrillation significantly decreased in the three groups,which were statistically different(P<0.01).The enalapril and folic acid group showed better protective effects than the other two groups.Compared with the amlodipine group,the levels of LAD and NT-proBNP in the enalapril group and the enalapril and folic acid group significantly decreased(P<0.01).Furthermore,compared with those in the enalapril group and the amlodipine group,remarkable decreases were found in Hcy,LAVI,TPSRg-SD,and TPSRs-SD in the enalapril and folic acid group,but increases were seen in LAFI,Sg,and SRs in the enalapril group and the amlodipine group(P<0.05).There were no reports concerning cardiac dysfunction,stroke or death in each group.Conclusions Enalapril and folic acid tablets can reduce the occurrence of atrial fibrillation in hypertension patients with hyperhomocysteinemia and paroxysmal atrial fibrillation,which may be associated with the mechanism of inhibiting atrial remodeling.