阿托伐他汀对高血压并发阵发性心房颤动的作用及机制

目的研究阿托伐他汀对高血压并发阵发性心房颤动（房颤）患者房颤再发率和持续性房颤发生率的影响。方法将87例高血压并发阵发性房颤患者随机分为2组：阿托伐他汀组45例,常规治疗的同时,予口服阿托伐他汀20 mg/d;对照组42例,仅给予常规治疗。追踪24个月,观察2组治疗1年后阵发性房颤再发率和持续性房颤的发生率,并检测治疗前及治疗1年后hsCRP、IL-6、TNF-α、肾素、AngⅡ的表达水平。结果阿托伐他汀组房颤再次发作7例（15.6%）,明显低于对照组（14例,33.4%）;阿托伐他汀组转为持续性房颤2例（4.5%）,亦明显低于对照组（5例,11.9%）;差异均有统计学意义（P〈0.05）。阿托伐他汀组治疗后血清hsCRP、IL-6、TNF-α、肾素、AngⅡ的水平,与对照组比较均下降,差异有统计学意义（P〈0.05）。所有再发房颤患者的血清hsCRP、IL-6、TNF-α、肾素、AngⅡ水平均比未再发房颤患者的明显升高,差异有统计学意义（P〈0.01）。结论高血压并发阵发性房颤的患者应用阿托伐他汀治疗,能够降低阵发性房颤的再发率,减少持续性房颤的发生率;提示炎症反应及肾素-血管紧张素-醛固酮系统的激活具有促进心房颤动的发生和持续的作用。

Study on the effect and mechanism of atorvastatin treating paroxysmal atrial fibrillation with hypertensive disease

Objective: To study the effect of atorvastatin on paroxysmal atrial fibrillation with hypertensive disease.Methods: Eighty-seven patients with paroxysmal atrial fibrillation and with hypertensive disease patients were divided into the two groups:the intervention group(45 cases) given 20 mg/d atorvastatin besides conventional therapy;the control group(42 cases) only given conventional therapy.Then the detections of ng the level of hsCRP,IL-6,TNF-α,rennin,AngⅡwas made in the 24 months follow-up before therapy and therapy one year after,and the rate of recurrence of paroxysmal atrial fibrillation and incidence rate of persistence atrial fibrillation were observed.All the cases were followed up 24 months,the level of hsCRP,IL-6,TNF-α,rennin and AngⅡ,the rate of recurrence of paroxysmal atrial fibrillation and incidence rate of persistence atrial fibrillation were all detected before and 1 year after therapy.Results: Changes of hsCRP,IL-6,TNF-α,rennin,AngⅡlevels in the intervention group were found significantly lower after one year therapy compared with those in the control group(P<0.05).There is a significantly lower rate of recurrence of paroxysmal atrial fibrillation in the intervention group(7 patients,15.6%) compared with that in the control group(14 patients,33.4%).There is a significantly lower incidence rate of persistence atrial fibrillation in the intervention group(2 patients,4.5%) compared with that in the control group(5 patients,11.9%,P<0.05).All recrudesced patients had significantly higher levels of hsCRP,IL-6,TNF-α,rennin,AngⅡcompared with those in no recrudesced patients(P<0.01).Conclusion: Atorvastatin can degrade the rate of recurrence of paroxysmal atrial fibrillation and incidence rate of persistence atrial fibrillation of with hypertensive disease.The study indicates that the inflammatory reaction and the activation of RAAS may promote the occurrence and maintenance of atrial fibrillation.