普伐他汀和缬沙坦联合应用对慢性心功能不全患者阵发性心房颤动的影响

目的探讨他汀类药物及血管紧张素受体拮抗剂对慢性心功能不全患者阵发性心房颤动的影响。方法145例伴有阵发性心房颤动的慢性心功能不全患者随机分为四组：胺碘酮组（Ⅰ组）、胺碘酮＋缬沙坦组（Ⅱ组）、胺碘酮＋普伐他汀组（Ⅲ组）、胺碘酮＋缬沙坦＋普伐他汀组（Ⅳ组），治疗随访2年，比较四组治疗前后左心房内径、C反应蛋白（CRP）水平变化及窦性心律维持率。结果治疗后，Ⅰ、Ⅱ、Ⅲ、Ⅳ组的左心房内径分别为（44．1±2．1）、（41．7±2．8）、（44．4±3．1）、（40．1±2．5）mm，Ⅰ组和Ⅲ组左心房内径均大于Ⅱ组和Ⅳ组（P〈0．05），而Ⅰ组和Ⅲ组，Ⅱ组和Ⅳ组比较差异无统计学意义；Ⅰ、Ⅱ、Ⅲ、Ⅳ组的CRP水平分别为（4．56±0．24）、（4．47±0．45）、（2．87±0．53）、（2．54±0．42）mg／L，Ⅰ组和Ⅱ组CRP水平高于Ⅲ组和Ⅳ组（P〈0．05），Ⅰ组和Ⅱ组、Ⅲ组和Ⅳ组比较差异无统计学意义；Ⅰ、Ⅱ、Ⅲ、Ⅳ组的窦性心律维持率分别为57．9％、79．4％、77．1％、85．3％，Ⅰ组窦性心律维持率低于Ⅱ、Ⅲ和Ⅳ组（P〈0．05）。结论缬沙坦和普伐他汀联合应用能减少慢性心力衰竭患者阵发性心房颤动的复发。缬沙坦能抑制左心房的扩大，而普伐他汀能有效降低血中CRP的水平。

Effect of pravastatin and valsartan on paroxysmal atrial fibrillation in patients with chronic congestive heart failure

Objective To investigate the effect of statins and angiotensin receptor blocker （ARB） on paroxysmal atrial fibrillation in patients with chronic congestive heart failure. Methods All of 145 patients with chronic congestive heart failure and paroxysmal atrial fibrillation were randomly divided into four groups, Ⅰ group （treated with amiedarone）, Ⅱ group （treated with amiodarone and valsartan）, Ⅲ group（treated with amiodarone and pravastatin）and Ⅳgroup （treated with amiodarone,valsartan and pravastatin）. After 2- year follow-up, observed the changes of left atrium diameter （LAD）, C-reactive protein （CRP） and maintenance rate of sinus rhythm before and after treatment. Results After treatment, the data of LAD of the four groups were （44.1 ±2.1 ）, （41.7 ± 2.8）, （44.4 ± 3.1 ）, （40.1 ± 2.5） mm respectively. The LAD data of both Ⅰ group and Ⅱ group were significantly higher than those of Ⅲ group and Ⅳ group （P〈0.05）,but there was no significant difference either between Ⅰ group and Ⅲ group, or between Ⅱ group and Ⅳ group. The levels of CRP of the four groups were （4.56 ± 0.24）, （4.47 ± 0.45 ）, （2.87 ± 0.53 ）, （2.54 ±0.42 ） mg/L respectively, and the levels of CRP of Ⅰ group and Ⅱ group were obviously higher than those of Ⅲ group and Ⅳ group （P 〈 0.05 ）, but there was no significant difference either between Ⅰ group and Ⅱ group,or between Ⅲ group and Ⅳ group. Maintenance rate of sinus rhythm of the four groups was 57.9%,79.4%,77.1%,85.3% respectively, the maintenance rate of sinus rhythm of Ⅰ group was significantly lower than that of Ⅱ, Ⅲ and Ⅳ group （P 〈 0.05）. Conclusions Valsartan and pravastatin may reduce recurrence of paroxysmal atrial fibrillation in patients with chronic congestive heart failure. Valsartan may inhibit dilatation of left atrium, and pravastatin may decrease the level of CRP in blood.