胃食管反流病合并房颤患者采用盐酸胺碘酮联合艾司奥美拉唑治疗效果及对炎症因子的影响

The mechanistic study of inflammatory response mediated atrial fibrillation induced by gastroesophageal reflux disease

目的探讨胃食管反流病(GERD)合并心房颤动(房颤)患者采用盐酸胺碘酮联合艾司奥美拉唑治疗后的临床疗效及其对炎症因子水平的影响。方法回顾性分析2018年1月至2019年12月在新疆维吾尔自治区人民医院住院收治的87例GERD合并房颤患者,根据治疗方式的不同,分为对照组(常规治疗的基础上给予盐酸胺碘酮治疗)和研究组(在对照组基础上联合给予艾司奥美拉唑治疗);2组均接收治疗1个月。采用GERD症状评分、胃食管24 h pH监测、高分辨率食管测压监测来分析2组治疗前后抑酸,胃食管动力及房颤发生的影响及疗效;收集2组患者治疗前后的血液标本,并采用ELISA法检测炎症因子(白细胞介素-6、C反应蛋白及肿瘤坏死因子-α)的变化水平。结果经食管24 h pH监测发现,研究组在GERD症状评分,食管近端弱酸反流(%)、食管近端酸反流(%)及DeMeester评分等指标,与其治疗前和对照组治疗后比较显著降低(P<0.05);高分辨率食管测压分析显示,与治疗前和对照组治疗后相比,研究组治疗后显著改善食管上段括约肌(UES)静息压、食管下段括约肌(LES)静息压及食管远端收缩积分(DCI)等指标(P<0.05);2组患者治疗后心率以及QT离散度(QTd)水平均显著小于治疗前(P<0.05),且研究组治疗后心率水平显著小于对照组治疗后的水平(P<0.05);2组患者治疗后动脉血压(收缩压、舒张压)水平均显著低于治疗前(P<0.05);治疗后2组炎症因子水平均明显低于治疗前(P<0.01),而研究组治疗后炎症因子水平明显低于对照组(P<0.05);研究组治疗后疗效明显高于对照组(P<0.05);而其无效率为显著低于对照组(P<0.05);研究组总有效率显著高于对照组(P<0.05)。结论该联合治疗在GERD合并房颤患者的疗效较好,降低炎性因子水平,显著改善症状及房颤的发生。

Objective To investigate the effect of amiodarone hydrochloride combined with esmeralazole on GERD patients with atrial fibrillation(AF).Methods A retrospective analysis was made on 87 GERD patients with AF whom admitted to our hospital from January 2019 to November 2019.According to the different treatment methods,the patients were further divided into two groups:the control group(treated with amiodarone hydrochloride and omeprazole)and the study group(treated with amiodarone hydrochloride and omeprazole);Both groups received treatment for one month.GERD symptom score,24 h pH monitoring and high-resolution esophageal manometry were used to analyze the effects of acid suppression,gastroesophageal motility and atrial fibrillation before and after treatment.Results After 24 h pH monitoring,GERD symptom score,esophageal proximal weak acid reflux(%),esophageal proximal acid reflux(%)and DeMmeester score in the study group were significantly lower than those before treatment and control group after treatment(P<0.05);The high-resolution esophageal manometry analysis showed that after the treatment the two group were equally improved resting pressure of lower esophageal sphincter(LES),resting pressure of upper esophageal sphincter(UES)and score of distal esophageal contraction(DCI)(P<0.05);After treatment,the curative effect of the study group was significantly higher than that of the control group(P<0.05);the invalid rate of the study group was significantly lower than that of the control group(P<0.05);the total effective rate of the study group was significantly higher than that of the control group(P<0.05).Conclusion The combined therapy is effective and safe in the treatment of GERD withAF,by acid suppression,esophageal motility,symptoms and atrial fibrillation.