美托洛尔联合沙库巴曲缬沙坦钠片对高血压合并心房颤动患者心率变异性及血BNP、AngII水平的影响

Effects of metoprolol combined with sacubitril valsartan sodium tablets on heart rate variability and blood B-type natriuretic peptide and angiotensinⅡlevels in patients with hypertension complicated with atrial fibrillation

目的探讨美托诺尔联合沙库巴曲缬沙坦钠片对高血压合并心房颤动(简称“房颤”)患者心率变异性、血清B型钠尿肽(BNP)和血管紧张素Ⅱ(AngⅡ)水平的影响。方法回顾性分析2020年6月至2023年6月期间驻马店市第一人民医院收治的162例高血压合并房颤患者的临床资料,根据用药不同分组,其中80例口服美托洛尔治疗者纳入常规组,82例在常规组治疗的基础上加服沙库巴曲缬沙坦钠片者纳入联合组,疗程均为6个月。比较两组患者治疗前后的血压、心率变异性和血清BNP、AngⅡ、明胶酶A(MMP-2)水平,同时比较两组患者的心房颤动及其他不良反应发生情况。结果治疗后,联合组患者的收缩压和舒张压分别为(127.15±8.48)mm Hg、(82.55±6.07)mm Hg,明显低于常规组的(132±10.54)mm Hg、(85.47±5.38)mm Hg,差异均有统计学意义(P<0.05);治疗后,联合组与常规组患者的窦性心率R-R间期的标准差(SDNN)[(155.06±16.91)ms vs(132.96±15.98)ms]、R-R间期均值的标准差(SDANN)[(145.92±30.55)ms vs(123.65±27.19)ms]、相邻R-R间期差均方根(r MSSD)[(39.15±5.02)ms vs(35.61±4.17)ms]、高频率段(HF)[(544.21±129.74)m^(2)vs(478.35±126.96)m^(2)]比较,联合组明显高于常规组,差异均有统计学意义(P<0.05);治疗后,联合组患者的低频率段(IF)为(357.14±90.28)m^(2),明显低于常规组的(423.61±101.65)m^(2),差异有统计学意义(P<0.05);治疗后,联合组与常规组患者的血清BNP[(115.03±15.62)ng/L vs(140.21±10.33)ng/L]、AngⅡ[(29.13±7.12)pg/mL vs(35.59±6.47)pg/mL]、MMP-2[(251.06±35.19)μg/L vs(278.31±42.16)μg/L]比较,联合组明显低于常规组,差异均有统计学意义(P<0.05);治疗后,联合组患者房颤发生次数为(11.07±2.83)次,明显少于常规组的(13.46±3.65)次,房颤持续时间为(5.86±1.18)h,明显短于常规组的(6.75±1.42)h,差异均有统计学意义(P<0.05);治疗期间联合组患者不良反应总发生率为10.98%,略高于常规组的3.75%,但差异无统计学意义(P>0.05)。结论美托洛尔联合沙库巴曲缬沙坦钠片治疗高血压合并房颤能够有效改善患者的心率变异性,降低血压及血清BNP、AngⅡ水平,减少房颤发作次数和持续时间,具有安全性。

Objective To explore the influence of metoprolol combined with sacubitril valsartan sodium tab-lets on heart rate variability and serum B-type natriuretic peptide(BNP)and angiotensinⅡ(AngⅡ)levels in patients with hypertension complicated with atrial fibrillation.Methods The clinical data of 162 patients with hypertension and atrial fibrillation in the First People's Hospital of Zhumadian from June 2020 to June 2023 were retrospectively analyzed.According to different medications,80 patients treated with metoprolol orally were included in conventional group,and 82 patients treated with sacubitril valsartan sodium tablets based on the treatment in conventional group were included in combined group,for 6 months.The blood pressure,heart rate variability,serum BNP,AngⅡ,matrix metalloproteinase-2(MMP-2)before and after treatment,and occurrence of atrial fibrillation and other adverse reactions were compared between the two groups.Results After treatment,the systolic blood pressure and diastolic blood pressure in the combined group were(127.15±8.48)mmHg and(82.55±6.07)mmHg,which were significantly lower than(132±10.54)mmHg and(85.47±5.38)mmHg in the conventional group(P<0.05).After treatment,the standard deviation of NN intervals(SDNN),standard deviation of the average NN intervals(SDANN),the root mean square of successive differences(rMS-SD),and high frequency(HF)in the combined group were(155.06±16.91)ms,(145.92±30.55)ms,(39.15±5.02)ms,(544.21±129.74)m^(2),which were significantly higher than(132.96±15.98)ms,(123.65±27.19)ms,(35.61±4.17)ms,(478.35±126.96)m^(2) in the combined group(P<0.05).After treatment,the low frequency(IF)in the combined group was(357.14±90.28)m^(2),which was significantly lower than(423.61±101.65)m^(2) in the conventional group(P<0.05).After treatment,the serum BNP,MMP-2,and AngⅡin the combined group were(115.03±15.62)ng/L,(29.13±7.12)pg/mL,and(251.06±35.19)μg/L,which were significantly lower than(140.21±10.33)ng/L,(35.59±6.47)pg/mL,and(278.31±42.16)μg/L in the conventional group(P<0.05).After treatment,the frequency of atrial fibrillation in the combined group was(11.07±2.83)times,which was significantly less than(13.46±3.65)times in the conventional group,and the duration of atrial fibrillation was(5.86±1.18)h,significantly shorter than(6.75±1.42)h in the conventional group(P<0.05).During the treatment,the total incidence of adverse reactions in the combined group was 10.98%,which was slightly higher than 3.75%in the conventional group,but the difference was not statistically significant(P>0.05).Conclusion Metoprolol combined with sacubitril valsartan sodium tablets in the treatment of hypertension with atrial fibrillation can effectively improve heart rate variability,lower blood pressure and serum BNP and AngⅡlevels,and reduce the frequency and duration of atrial fibrillation,with good safety.