厄贝沙坦联合阿托伐他汀对急性心肌梗死合并阵发性心房颤动患者复发的影响

摘要

目的 探讨厄贝沙坦联合阿托伐他汀对合并阵发性心房颤动(PAF)的急性心肌梗死(AMI)患者心房颤动复发的防治作用.方法 选择AMI合并PAF患者129例,按照随访期间药物应用情况分为联合组(67例)、阿托伐他汀组(21例)、厄贝沙坦组(23例)和对照组(18例).观察各组血压、血脂、左心房内径及血浆C反应蛋白水平的变化,记录PAF复发或转为持续性及永久性心房颤动的发生情况.结果 治疗后,联合组及厄贝沙坦组收缩压及左心房内径均低于阿托伐他汀组及对照组,差异有统计学意义(P＜0.05).治疗后,联合组及阿托伐他汀组TC、TG、LDL-C、C反应蛋白低于厄贝沙坦组及对照组,差异有统计学意义(P＜0.05).与联合组比较,阿托伐他汀组和厄贝沙坦组PAF复发率及转为持续性、永久性心房颤动的比例升高;与对照组比较,阿托伐他汀组和厄贝沙坦组PAF复发率及转为持续性、永久性心房颤动的比例明显降低(P＜0.05).阿托伐他汀(OR=0.42,95％CI：0.26～0.89)及厄贝沙坦(OR=0.47,95％ CI：0.30～0.81)为预防AMI患者心房颤动复发的保护性因素.结论 厄贝沙坦联合阿托伐他汀对合并PAF的AMI患者心房颤动复发具有明显的防治作用,其机制可能与抑制炎性反应及调脂、改善心房电重构及结构重构有关.%Objective To evaluate the effect of irbesartan combined with atorvastatin on relapse of paroxysmal atrial fibrillation(PAF) in patients with acute myocardial infarction (AMI) complicated by PAF. Methods According to the drug used during follow-up, 129 AMI patients with PAF were divided into group I (combined treatment group),group Ⅱ (atorvastatin group),group Ⅲ (irbesartan group) and group IV (control group). Blood pressure,blood lipids,left atrial diameter and plasma C-reactive protein(CRP) level were recorded at the acute period and the end of the follow-up. Recurrence of PAF or conversion to persistent and permanent atrial fibrillation was observed. Results After treatment, SBP and left atrial diameter in groups I and Ⅲ were significantly lower than those in groups Ⅱ and IV , while TC, TG, LDL-C, and CRP in group I and group I[ were significantly lower than those in group Ⅱ and group IV. Patients in group I had the lowest recurrence rate of PAF and the incidence rate of persistent or permanent atrial fibrillation during follow-up while those rates were lower in group II and group HI than in group IV. Both atorvastatin and irbesartan were protective factors for preventing relapse of PAF in AMI patients. Conclusions Irbesartan combined with atorvastatin can effectively inhibit the relapse of PAF in patients with AMI. The mechanism is probably related to inhibiting inflammatory reaction, modulating serum lipids and improving atrial electric and structural remodeling.