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目的探讨瑞舒伐他汀预防高血压伴阵发性心房颤动(房颤)患者房颤再发的效果及可能机制研究。方法选取2011年1月至2014年1月广州医科大学附属第三医院心内科就诊的高血压伴阵发性房颤患者164例(含11例脱出病例)作为研究对象,采用随机数字表法分为对照组和观察组各82例,剔除脱落病例,观察组最终纳入78例,对照组纳入75例。对照组口服胺碘酮,第1周600 mg/d,每周递减200 mg/d,第4周起以100 mg/d维持;观察组在对照组基础给予瑞舒伐他汀10 mg/d口服,均持续治疗12个月。记录两组房颤复发率,观察两组治疗前后炎性因子、凝血因子及超声心动图指标变化,对比房颤再发组和房颤未再发组上述指标变化,并采用Logistic回归模型分析房颤预测因子。结果治疗后观察组白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)、可溶性P-选择素(s P-selectin)、纤维蛋白原(FIB)、血管紧张素Ⅱ(AngⅡ)、左房前后径(LAD)、右房上下径(RAD)、室间隔收缩期厚度(IVSD)、左室射血分数(LVEF)显著低于对照组,差异有统计学意义(P<0.05);房颤再发组IL-6、TNF-α、hs-CRP、s P-selectin、FIB、AngⅡ、LAD、RAD、IVSD显著高于房颤未再复发组,差异有统计学意义(P<0.05);Logistic回归模型分析房颤预测因子发现TNF-α(OR=1.461,95%CI:0.975~1.952)、s P-selectin(OR=1.156,95%CI:1.052~1.275)、AngⅡ((OR=1.234,95%CI:1.101~1.426)、LAD(OR=1.402,95%CI:1.342~1.661)是房颤的独立预测因素。结论瑞舒伐他汀可降低高血压伴阵发性房颤患者房颤再发率,可能与减少炎症、高凝状态相关。
Objective To investigate the effect and possible mechanism of rosuvastatin in preventing atrial fibrillation recurrence in patients with hypertension and paroxysmal atrial fibrillation (AF). Methods A total of 164 hypertensive patients with paroxysmal atrial fibrillation (including 11 cases of prolapse) admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 2011 to January 2014 were enrolled in this study. The random number table For the control group and the observation group of 82 cases, excluding shedding cases, the observation group eventually included 78 cases, the control group included 75 cases. The control group received amiodarone orally at 600 mg / d in the first week, decreasing 200 mg / d weekly and 100 mg / d starting from the fourth week. The observation group was orally administered rosuvastatin 10 mg / d on the basis of the control group , Continued treatment for 12 months. The relapse rate of atrial fibrillation in both groups was recorded. The changes of inflammatory factors, coagulation factors and echocardiographic parameters before and after treatment were observed. The changes of the above indexes in atrial fibrillation recurrence group and atrial fibrillation group were compared. Logistic regression analysis Fibrillation predictors. Results After treatment, the levels of IL-6, TNF-α, hs-CRP, s P-selectin, fibrinogen FIB, LVEF, LAD, RAD, IVSD and LVEF were significantly lower than those of the control group, The difference was statistically significant (P <0.05). IL-6, TNF-α, hs-CRP, s P-selectin, FIB, AngⅡ, LAD, (OR = 1.461,95% CI: 0.975-1.9552), s P-selectin (OR = 1.156,95%), the difference was statistically significant (P <0.05); Logistic regression analysis showed that TNF- CI: 1.052-1.275), AngⅡ (OR = 1.234, 95% CI: 1.101-1.426), LAD (OR = 1.402, 95% CI: 1.342-1.661) were independent predictors of atrial fibrillation.Conclusion Rosuvastatin Can reduce the incidence of atrial fibrillation recurrence in patients with hypertension and paroxysmal atrial fibrillation, may be related to reducing inflammation, hypercoagulable state.