高血压患者心房颤动急性发作后内皮功能生物学标志的改变

目的 观察高血压患者发生急性心房颤动(房颤)后其内皮功能生物学标志的改变.方法 高血压患者房颤急性发作者37例,在发作时间小于48h内复律,未给予抗凝治疗,复律后窦性心律维持1个月以上.根据是否服用血管紧张素转换酶抑制剂(ACEI)和(或)血管紧张素受体拮抗剂(ARB)分为两组:急性房颤1组(使用ACEI/ARB,n=17)和急性房颤2组(未使用ACEI/ARB,n=20),选择20例高血压合并窦性心律者为对照组.急性房颤患者分别于复律前,复律后1、7、14和30天检测血浆内皮素(ET)、一氧化氮(NO)、假性血友病因子(vWF)及可溶性E-选择素水平,并与对照组进行比较.结果 两个急性房颤组房颤急性发作时ET、vWF和E-选择素水平均显著高于对照组,NO水平显著低于对照组;两急性房颤组间上述指标无显著差异.复律后ET在急性房颤1组于第7天降至对照组水平,急性房颤2组于第30天降至对照组水平;NO、vWF水平在急性房颤1组于第14天恢复至对照组水平,急性房颤2组于第30天恢复至对照组水平;两组急性房颤患者E-选择素均于复律后第1天迅速上升,于第7天基本恢复到对照组水平.结论 高血压患者房颤急性发作时存在内皮功能障碍,复律后其内皮功能障碍可持续相当一段时间,ACEI/ARB类药物有助于其内皮功能的恢复.

Changes in biomarkers of endothelial function after the onset of atrial fibrillation in hypertensives

Objective To assess endothelial function before and after pharmacological cardioversion for acute onset of atrial fibrillation(AF)in the patients with hypertension.Methods 37 consecutive hypertensive patients with acute AF were investigated,in whom sinus rhythm was restored by pharmacological cardioversion within 48 hours of arrhythmia onset without anticoagulant treatment.Of these 37 patients,17 cases treated with ACEI/ARB drugs were assigned to acute AF group 1,20 cases without using ACEI/ARB drugs were assigned to acute AF group 2.20 hypertensive patients with sinus rhythm were included as control group.Plasma markers of endothelial damage/dysfunction [von Willebrand factor(vWF),endothelin(ET)and nitric oxide(NO)] and E-selectin(E-sel,an index of endothelial activation)were measured in acute AF at baseline(pre-cardioversion)and on days 1,7,14,and 30 after cardioversion.The detected results were compared with the levels of controls.Results Plasma concentrations of ET,vWF and E-sel in acute AF group were significantly higher than those of control group;plasma level of NO in acute AF group was significantly lower compared to that of control group.After cardioversion,the plasma levels of ET decreased gradually to the levels of controls by the 7th day of sustaining sinus rhythm in acute AF group 1 and 30th day in acute AF group 2,and the plasma levels of vWF decreased to approach that of controls by the 14th day post-cardioversion in acute AF group 1 and 30th day in acute AF group 2.The NO level gradually increased to that of controls by the 14th day of sustaining sinus rhythm in acute AF group 1 and 30th day in acute AF group 2.Plasma level of E-sel returned to normal by the 7th day in the both groups of acute AF.Conclusion There were evidences of endothelial damage or dysfunction at acute onset of AF among the patients with hypertension,which persisted up to 30 days after cardioversion,and the use of ACEI/ARB might improve the normalization of endothelial function after cardioversion.