西拉普利对心房颤动患者内皮和纤溶功能的影响

Effects of cilazapril on endothelial and flbrinolytic function in atrial fibrillation.

目的观察临床心房颤动(AF)患者内皮及纤溶功能及西拉普利对其影响,探讨 AF 血栓前状态的机制及防治对策。方法临床慢性 AF 患者63例,随机分为西拉普利干预组(33)和对照组(30),在常规治疗基础上,干预组给予西拉普利2.5mg/d 2用;均在入选前及2周后采清晨空腹静脉血,测血浆 vWF、AngⅡ、t-PA 抗原、PAI-1抗原。同时,随机选同期体检患者36例窦性心律者,作为非 AF 对照。结果 AF 患者血浆 AngⅡ浓度较窦律组高[(107.7±22.0)pg/mL 对(70.2±15.8)pg/mL,P<0.05],西拉普利组血浆AngⅡ浓度明显降低(P<0.05);AF 患者血浆 vWF、t-PA、PAI-1抗原较窦律组明显升高[vWF:(125.9±20.4)%对(99.1±19.5)%,P<0.05][t-PA:(23.6±4.7)ng/mL 对(14.4±4.5)ng/nL,P<0.01)][PAI-1:(54.2±7.6)ng/mL 对(31.7±9.7)ng/mL,P<0.01];西拉普利组治疗后均显著下降(P<0.01)。结论 AF 患者存在 RAS 激活、内皮功能及纤溶功能失调,ACEI 可阻断 RAS 活性、改善内皮和纤溶功能,有可能用于房颤血栓防治。

Objective To observe endothelial and fibrinolytic functions of clinical AF patients and effects of cilazapril on it and to investigate the mechanism and treatments of thrombogenesis in AF.Methods 63 AF patients were randomly divided into control group(n=30)and cilazapril group(n=33).All patients received general treatment according symptoms.In addition,the patients in cilazapril group received cilazapril(2.5mg/d,2 weeks).Plasma Ang Ⅱ, vWF,t-PA and PAI-1 level were measured before and after 2 weeks.There were 36 patients with sinus rhythm (SH)in non-AF control group.Results AF patients had higher plasma Angll level than SH patients that indicated RAS activated[(107.7±22.0)pg/mL vs(70.2±15.8)pg/mL,P<0.05].Compared with SH patients,the AF patients had the plasma vWF,t-PAandPAI-1 level markedly increased[vWF:(125.9±20.4)% vs(99.1± 19.5)%,P<0.05]; [t-PA:(23.6±4.7)ng/mL vs(14.4±4.5)ng/mL,P<0.01]; [PAI-1:(54.2± 7.6)ng/mL vs(31.7±9.7)ng/mL,P<0.01]; in AF vs in SH,respectively).All indexes had decreased in Cilazapril group.Conclusion RAS is activated in AF and results in endothelial and fibrinolytic dysfunctions which may play an important role in AF patients,cilazapril could inhibit RAS and improve endothelial and fibrinolytic dysfunctions in AF.