不同剂量的替米沙坦对阵发性心房颤动的影响

目的：观察不同剂量的替米沙坦对阵发性心房颤动的预防效果,并探讨其量效关系和主要作用机制。方法：将符合入选条件的123例高血压病合并心功能不全或左室肥厚或冠心病患者随机分为替米沙坦20mg组（n=30）、40mg组（n=30）、80mg组（n=31）和对照组（n=32）。各组均口服相同剂量和时间的胺碘酮,对照组避免应用血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体拮抗剂（ARB）。随访6个月,分别观察房颤复发例数、房颤发作次数、房颤首次复发时间及左室、左房内径的变化。结果：替米沙坦80mg组房颤首次复发的时间较对照组显著延长（P〈0.05）,房颤复发例数与次数6个月内显著减少（P〈0.05）,左室舒张末内径（LVEDD）与左房内径（LAD）在3个月内与对照组比较无显著差异（P〉0.05）,6个月内显著缩短（P〈0.05）。20mg组、40mg组与对照组比较差异均无统计学意义（P〉0.05）。结论：不同剂量的替米沙坦对预防房颤复发的效果不同,存在着量效关系,其作用机制主要与抑制心室、心房重构的强弱有关。

Effects of Different Doses of Telmisartan on Paroxysmal Atrial Fibrillation

Objective：To investigate effects of different doses of telmisartan on the prevention of paroxysmal atrial fibrillation and explore dose-response relations and mechanisms.Methods： A total of 123 hypertensive patients with cardiac insufficiency or left ventricular hypertrophy or coronary heart disease,who were met the inclusion criteria,were randomly divided into telmisartan 20mg（n=30）,40mg（n=30）,80mg（n=31） and the control group（n=32）,respectively.Patients in telmisartan groups and control group were treated with the same dosage and administration duration of amiodarone.Patients in the control group were administered other antihypertensive drugs excluding angiotensin converting enzyme inhibitors（ACEI） and angiotensin receptor blockers（ARB）.All the patients were followed up for six months.The numbers of cases of atrial fibrillation recurrence,episodes of atrial fibrillation,time of the first atrial fibrillation recurrence and changes of left atrial and ventricular dimension were recorded.Results： There was more prolonged first recurrence time（P〈0.05）,less episodes of atrial fibrillation and numbers of cases of atrial fibrillation recurrence（P〈0.05） in telmisartan 80mg group compared with those of the control group in six months.Left ventricular end diastolic and left atrial dimension showed similar results between telmisartan 80mg group and control group during the three-month tracing period（P〈0.05） while reduced significantly in six months（P〈0.05）.All of the indicators mentioned above in telmisartan 20mg and 40mg group were not significantly different from the control group（P〈0.05）.Conclusions： Different doses of telmisartan have different effects on preventing atrial fibrillation recurrence and there are dose-response relations between telmisartan and its effect.The mechanism of effects is primarily relevant to degrees of inhibition of atrial and ventricular remodeling.