曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

目的 探讨曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效及对左心房内径、C-反应蛋白(CRP)的影响.方法 原发性高血压伴阵发性心房颤动患者160例,随机分为4组:均给予钙离子拮抗剂降压治疗,部分患者加用利尿剂.40例(对照组)常规服用胺碘酮(可达龙,杭州赛诺菲圣德拉堡民生制药有限公司)治疗,第1周600 mg/d,第2周400 mg/d,以后200 mg/d;40例(阿托伐他汀组)在对照组治疗基础上加用阿托伐他汀(阿乐,北京嘉林药业股份有限公司)20 mg/d;40例(曲美他嗪组)在对照组治疗基础上加用曲美他嗪(万爽力,法国施维雅药厂)20 mg/次,每日3次治疗;40例(曲美他嗪联舍阿托伐他汀组)在对照组治疗基础上加用曲美他嗪和阿托伐他汀,用法用量同上.4组患者均于心房颤动复律后24h内开始服药,服药时间均为1年.观察4组治疗前后疗效及左心房内径、CRP的变化.结果 ①1年后除阿托伐他汀组外其余3组各失访1例,对照组有效率38.4%(15/39),阿托伐他汀组62.5%(25/40),曲美他嗪组64.1%(25/39),曲美他嗪联合阿托伐他汀组84.6%(33/39),后3组有效率与对照组比较差异均有统计学意义(X2分别为4.56、5.13、17.55,P均<0.05);曲美他嗪联合阿托伐他汀组有效率显著高于阿托伐他汀组(X2=4.95,P<0.05)和曲美他嗪组(X2=4.30,P<0.05);阿托伐他汀组与曲美他嗪组比较,差异无统计学意义(X2=0.03,P>0.05).② 4组治疗前左心房内径差异无统计学意义(F=1.68,P>0.05);治疗后左心房内径对照组为(40.96±1.81)mm,阿托伐他汀组为(38.65±1.90)mm,曲美他嗪组为(39.15±1.85)mm,曲美他嗪联合阿托伐他汀组为(37.22±1.74)mm,组阃比较差异有统计学意义(F=3.42,P<0.05);曲美他嗪联合阿托伐他汀组显著小于阿托伐他汀组(P<0.05)和曲美他嗪组(P<0.05),阿托伐他汀组与曲美他嗪组比较,差异无统计学意义(P>0.05).4组治疗前CRP差异无统计学意义(F=0.96,P>0.05);治疗后对照组CRP为(8.85±1.45)mg/L,阿托伐他汀组为(5.96±1.26)mg/L,曲美他嗪组为(6.81±1.37)mg/L,曲美他嗪联合阿托伐他汀组为(3.75±1.15)mg/L,组闻比较差异有统计学意义(F=3.63,P<0.05);曲美他嗪联合阿托伐他汀组显著低于阿托伐他汀组(P<0.05)和曲美他嗪组(P<0.05);阿托伐他汀组与曲美他嗪组比较,差异无统计学意义(P>0.05).结论 曲美他嗪联合阿托伐他汀能通过抗炎、抑制左心房重构作用预防阵发性心房颤动复发.

The efficacy of trimetazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.