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目的:研究辛伐他汀对高血压并发阵发性心房颤动(房颤)患者房颤再发率和持续性房颤发生率的影响以及其对血高敏C反应蛋白(hsCRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及肾素、血管紧张素Ⅱ(AngⅡ)的水平的影响。方法:将87例高血压并发阵发性房颤患者随机分为2组:辛伐他汀组45例,常规治疗的同时,予口服辛伐他汀20mg/d;对照组42例,仅给予常规治疗。追踪24个月,观察2组治疗1年后阵发性房颤再发率和持续性房颤的发生率,并检测治疗前及治疗1年后hsCRP、IL-6、TNF-α、肾素、AngⅡ的表达水平。结果:辛伐他汀组房颤再次发作7例(15.6%),明显低于对照组(14例,33.4%);辛伐他汀组转为持续性房颤2例(4.5%),亦明显低于对照组(5例,11.9%);差异均有统计学意义(P<0.05)。辛伐他汀组治疗后血清hsCRP、IL-6、TNF-α、肾素、AngⅡ的水平,与对照组比较均下降,差异有统计学意义(P<0.05)。所有再发房颤患者的血清hsCRP、IL-6、TNF-α、肾素、AngⅡ水平均比未再发房颤患者的明显升高,差异有统计学意义(P<0.01)。结论:高血压并发阵发性房颤的患者应用辛伐他汀治疗,能够降低阵发性房颤的再发率,减少持续性房颤的发生率,而且降低血清hsCRP、IL-6、TNF-α、肾素、AngⅡ的水平,后者可能与房颤再发相关,提示炎症反应及肾素-血管紧张素-醛固酮系统的激活具有促进心房颤动的发生和持续的作用。
Objective: To investigate the effect of simvastatin on the incidence of atrial fibrillation (AF) and persistent atrial fibrillation (AF) in patients with hypertension complicated by paroxysmal atrial fibrillation (AF) and the effect of simvastatin on serum hsCRP, 6 (IL-6), tumor necrosis factor-α (TNF-α) and renin, angiotensin Ⅱ (Ang Ⅱ) levels. Methods: Eighty-seven patients with hypertension complicated with paroxysmal atrial fibrillation were randomly divided into 2 groups: simvastatin group (n = 45), routine treatment with simvastatin 20 mg / d, control group (n = 42) . The patients were followed up for 24 months. The incidence of paroxysmal atrial fibrillation recurrence and persistent atrial fibrillation after 1 year of treatment were observed. The levels of hsCRP, IL-6, TNF-α, renin , Ang Ⅱ expression level. Results: Seven cases (15.6%) of atrial fibrillation in simvastatin group were significantly lower than those in control group (14.4%, 33.4%). Simvastatin group was changed to persistent atrial fibrillation in 2 cases (4.5%), also significantly lower In the control group (5 cases, 11.9%), the differences were statistically significant (P <0.05). Compared with the control group, the levels of hsCRP, IL-6, TNF-α, renin and AngⅡ in simvastatin group were significantly decreased after treatment (P <0.05). The serum levels of hsCRP, IL-6, TNF-α, renin, and AngⅡ in all patients with atrial fibrillation were significantly higher than those without atrial fibrillation (P <0.01). Conclusions: Simvastatin treatment in patients with hypertension complicated with paroxysmal atrial fibrillation can reduce the recurrence rate of paroxysmal atrial fibrillation, reduce the incidence of persistent atrial fibrillation, reduce the serum levels of hsCRP, IL-6 and TNF- α, renin and AngⅡ. The latter may be related to the recurrence of atrial fibrillation, suggesting that the inflammatory response and the activation of the renin-angiotensin-aldosterone system may promote the occurrence and persistence of atrial fibrillation.