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目的研究缬沙坦对高血压病合并阵发性心房颤动(房颤)患者复律后阵发性房颤的再发率、持续性房颤的发生率以及高敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、心房利钠肽(ANP)水平及左心房内径(LAD)的影响,探讨缬沙坦的抗房颤作用及机制。方法 90例高血压合并初发阵发性房颤患者,随机分成治疗组(n=45)和对照组(n=45)。在常规治疗的基础上,治疗组给予缬沙坦降压治疗,对照组给予硝苯地平控释片(拜新同)降压治疗,治疗周期1年。观察2组阵发性房颤复律后的再发率和持续性房颤的发生率,并检测2组治疗前后hs-CRP、IL-6、TNF-α、LAD及ANP的变化。结果治疗组房颤再次发作7例(15.6%),略低于对照组(14例,31.1%);治疗组转为持续性房颤2例(4.4%),略低于对照组(5例,11.1%),但差异均无统计学意义(P均>0.05)。治疗组治疗后hs-CRP、IL-6、TNF-α、LAD及ANP水平,均较对照组下降明显,差异有统计学意义(P均<0.05)。结论高血压病合并阵发性房颤患者用缬沙坦治疗,能够降低炎症因子及ANP水平、减小LAD,有降低阵发性房颤的再发率及持续性房颤发生率的趋势。
Objective To investigate the relapse rate of paroxysmal atrial fibrillation, the incidence of persistent atrial fibrillation and high-sensitivity C-reactive protein (hs-CRP) in valsartan patients with hypertension complicated with paroxysmal atrial fibrillation (AF) (IL-6), tumor necrosis factor-α (TNF-α), atrial natriuretic peptide (ANP) and left atrium diameter (LAD) mechanism. Methods Ninety patients with essential hypertension complicated with primary paroxysmal atrial fibrillation were randomly divided into treatment group (n = 45) and control group (n = 45). On the basis of routine treatment, the treatment group was given valsartan antihypertensive treatment, the control group was given nifedipine controlled release tablets (thanks to the new) antihypertensive treatment, the treatment cycle of 1 year. The recurrence rate and the incidence of persistent atrial fibrillation were observed in two groups after cardioversion. The changes of hs-CRP, IL-6, TNF-α, LAD and ANP in two groups before and after treatment were also observed. Results The incidence of atrial fibrillation in treatment group was 7 cases (15.6%) again, slightly lower than that in control group (14 cases, 31.1%). The treatment group was changed to persistent atrial fibrillation in 2 cases (4.4% , 11.1%), but the difference was not statistically significant (P all> 0.05). Compared with the control group, the levels of hs-CRP, IL-6, TNF-α, LAD and ANP in the treatment group decreased significantly (all P <0.05). Conclusion The treatment of valsartan with hypertension in patients with paroxysmal atrial fibrillation can reduce the levels of inflammatory factors and ANP, reduce the LAD, reduce the recurrence rate of paroxysmal atrial fibrillation and the incidence of persistent atrial fibrillation.