【摘要】：目的:1、觀察氟伐他汀及聯(lián)合應(yīng)用纈沙坦對(duì)高血壓合并非永久性心房顫動(dòng)的上游治療效果;2、觀察氟伐他汀對(duì)陣發(fā)性心房顫動(dòng)的臨床效果。方法:1、入選2013年2月至2016年7月就診于天津醫(yī)科大學(xué)第二醫(yī)院、天津市人民醫(yī)院、天津市東麗醫(yī)院等8個(gè)中心的門診及住院部的確診為高血壓合并非永久性房顫患者共143例,隨機(jī)分為三組:鈣拮抗劑(CCB)組(n=47),CCB+氟伐他汀組(n=46),纈沙坦+氟伐他汀組(n=50)。治療方案:CCB組使用二氫吡啶類,但局限于使用氨氯地平、硝苯地平和非洛地平。氟伐他汀+CCB組:氟伐他汀40~80mg q.n.+CCB;氟伐他汀+纈沙坦組:氟伐他汀40~80mg q.n.+纈沙坦,三個(gè)組均治療隨訪24個(gè)月。觀察三個(gè)治療組治療24個(gè)月后的竇性心律維持率、持續(xù)性房顫的發(fā)生率、房顫負(fù)荷及心率變異性,并監(jiān)測(cè)三組治療前后左房?jī)?nèi)徑(left atrial diameter,LAD)、超敏C反應(yīng)蛋白(high sensitive C reactive protein,hs-CRP)、血脂指標(biāo)(TG,TC,LDL-C)以及肝、腎功能的變化。2、入選2014年7月至2016年7月就診于天津醫(yī)科大學(xué)第二醫(yī)院門診的確診為陣發(fā)性房顫的患者共80例,隨機(jī)分為觀察組(n=40)和對(duì)照組(n=40)。對(duì)照組服用抗心律失常藥物,觀察組在對(duì)照組的基礎(chǔ)上加用氟伐他汀,觀察并比較兩組治療1年后的竇性心律維持率、持續(xù)性房顫的發(fā)生率以及治療前后的LAD、hs-CRP、血脂、肝腎功能等指標(biāo)變化。結(jié)果:1、治療觀察24個(gè)月后,實(shí)際完成整個(gè)研究的患者共134例:CCB組(n=41),CCB+氟伐他汀組(n=45),纈沙坦+氟伐他汀組(n=48)。三個(gè)治療組在年齡、性別、吸煙、飲酒、糖尿病、腦卒中、抗心律失常藥物用藥史等臨床資料及血糖、心肌酶(CK-MB、cTnI)、NT-ProBNP、血壓、肝功能(ALT、AST)、腎功能(Cr)、血脂(TG、TC、LDL-C)水平等血生化資料方面無(wú)顯著統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。(1)氟伐他汀+CCB組、氟伐他汀+纈沙坦組治療后的竇性心律維持率高于CCB治療組(77.78%,79.19%vs 43.90%),持續(xù)性房顫發(fā)生率顯著低于CCB治療組[5(11.11%),4(8.33%)vs 13(31.71%)],差異有統(tǒng)計(jì)學(xué)意義(P0.05);(2)治療后氟伐他汀+CCB組、氟伐他汀+纈沙坦組較CCB組陣發(fā)性房顫持續(xù)時(shí)間百分比縮短,分別為[8.4%(5.8%,14.4%),10.4%(4.5%,13.9%)vs 23.4%(15.4%,29.8%)](P0.05);(3)治療后氟伐他汀+CCB組、氟伐他汀+纈沙坦組的f-f間期較前延長(zhǎng),f波振幅較前增高(P0.05),而CCB組f-f間期及f波振幅較前無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05);(4)CCB組治療前后血脂指標(biāo)及hs-CRP水平、左房?jī)?nèi)徑大小均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),氟伐他汀+CCB組、氟伐他汀+纈沙坦組治療后上述指標(biāo)較治療前均明顯降低(P0.05)。(5)三個(gè)治療組治療前后肝、腎功能無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。2、治療觀察12個(gè)月后,實(shí)際完成整個(gè)研究的患者共74例:氟伐他汀觀察組(n=38),對(duì)照組(n=36)。兩組在年齡、性別、吸煙、飲酒、糖尿病、腦卒中、抗心律失常藥物用藥史等臨床資料及血糖、心肌酶(CK-MB、cTnI)、NT-ProBNP、血壓、肝功能(ALT、AST)、腎功能(Cr)、血脂(TG、TC、LDL-C)水平等血生化資料方面無(wú)顯著統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。治療1年后,氟伐他汀觀察組的竇性心律維持率顯著高于對(duì)照組(84.21%vs61.11%),持續(xù)性房顫發(fā)生率低于對(duì)照組(5.26%vs 22.22%),差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)照組治療前后血脂指標(biāo)及hs-CRP水平、左房?jī)?nèi)徑大小均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),而觀察組治療后上述指標(biāo)較治療前均明顯降低(P0.05)。觀察組治療后血脂指標(biāo)、hs-CRP水平及左房?jī)?nèi)徑大小顯著低于對(duì)照組,有統(tǒng)計(jì)學(xué)差異(P0.05)。兩組治療前后肝、腎功能指標(biāo)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:非永久性心房顫動(dòng)患者在常規(guī)抗心律失常治療的基礎(chǔ)上加用氟伐他汀或氟伐他汀聯(lián)合纈沙坦,在降低血脂指標(biāo)的同時(shí),可進(jìn)一步提高竇性心律維持率,減少持續(xù)性房顫的發(fā)生率,降低房顫負(fù)荷,改善心房重構(gòu),減少炎癥反應(yīng),未增加肝、腎功能損害等不良反應(yīng),可用于心房顫動(dòng)的二級(jí)預(yù)防和治療。
[Abstract]:Objective: 1. To observe the upstream effect of fluvastatin and Valsartan in the treatment of hypertension with non-permanent atrial fibrillation; 2. To observe the clinical effect of fluvastatin on paroxysmal atrial fibrillation. Methods: 1. Patients were enrolled in the Second Hospital of Tianjin Medical University, Tianjin People's Hospital, Tianjin Dongli Hospital from February 2013 to July 2016. 143 patients with hypertension and non-permanent atrial fibrillation were randomly divided into three groups: calcium antagonist (CCB) group (n = 47), CCB + fluvastatin group (n = 46) and valsartan + fluvastatin group (n = 50). Fluvastatin + CCB group: Fluvastatin 40-80mg q.n. + CCB; Fluvastatin + Valsartan group: Fluvastatin 40-80mg q.n. + Valsartan, all three groups were followed up for 24 months. The maintenance rate of sinus rhythm, incidence of persistent atrial fibrillation, load of atrial fibrillation and heart rate variability were observed after 24 months of treatment in the three groups. Eighty patients with paroxysmal atrial fibrillation admitted to the Second Hospital of Tianjin Medical University from July 2014 to July 2016 were randomly divided into observation group (n=40). The control group was treated with antiarrhythmic drugs and the observation group was treated with fluvastatin on the basis of the control group. The maintenance rate of sinus rhythm, the incidence of persistent atrial fibrillation and the changes of LAD, hs-CRP, blood lipids, liver and kidney function before and after treatment were observed and compared between the two groups. A total of 134 patients completed the study: CCB group (n = 41), CCB + fluvastatin group (n = 45), valsartan + fluvastatin group (n = 48). (Cr), blood lipids (TG, TC, LDL-C) levels and other blood biochemical data were not significantly different (P 0.05), with comparability. (1) Fluvastatin + CCB group, fluvastatin + valsartan group after treatment sinus rhythm maintenance rate was higher than CCB group (77.78%, 79.19% vs 43.90%), the incidence of persistent atrial fibrillation was significantly lower than CCB group [5 (11.11%), 4 (8.33%) vs 13 (8.33%). 31.71%], the difference was statistically significant (P 0.05); (2) after treatment, fluvastatin + CCB group, fluvastatin + valsartan group paroxysmal atrial fibrillation duration percentage shorter than CCB group, respectively [8.4% (5.8%, 14.4%), 10.4% (4.5%, 13.9%) vs 23.4% (15.4%, 29.8%)] (P 0.05); (3) after treatment, fluvastatin + CCB group, fluvastatin + valsartan group f-f interval was shorter than before treatment; (3) fluvastatin + CCB group, fluvastatin + valsartan group The F-wave amplitude increased significantly (P 0.05), while the f-f interval and F-wave amplitude of CCB group had no significant difference (P 0.05); (4) There was no significant difference in serum lipid index, hs-CRP level and left atrial diameter before and after treatment in CCB group (P 0.05). In fluvastatin + CCB group, fluvastatin + valsartan group, the above indexes were significantly lower than before treatment (P 0.05). (5) There was no significant difference in liver and kidney function between the three treatment groups before and after treatment (P 0.05). After 12 months of treatment, 74 patients actually completed the study: fluvastatin observation group (n = 38), control group (n = 36). The two groups in age, sex, smoking, drinking, diabetes, stroke, antiarrhythmic drug history and other clinical data and blood. Blood biochemical data such as glucose, cardiac enzymes (CK-MB, cTnI), NT-ProBNP, blood pressure, liver function (ALT, AST), renal function (Cr), blood lipids (TG, TC, LDL-C) were not significantly different (P 0.05), and were comparable. After one year of treatment, the maintenance rate of sinus rhythm in fluvastatin group was significantly higher than that in control group (84.21% vs 61.11%). The incidence of persistent atrial fibrillation was low. In the control group (5.26% vs 22.22%), the difference was statistically significant (P There was no significant difference in liver and kidney function between the two groups before and after treatment (P 0.05). Conclusion: Fluvastatin or fluvastatin combined with valsartan in patients with non-permanent atrial fibrillation on the basis of routine antiarrhythmic treatment can further improve sinus rhythm and reduce blood lipid index. Holding rate, reducing the incidence of persistent atrial fibrillation, reducing the load of atrial fibrillation, improving atrial remodeling, reducing inflammation, without increasing liver and kidney function damage and other adverse reactions, can be used for secondary prevention and treatment of atrial fibrillation.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.75

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