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目的:探讨阵发性心房颤动(房颤)患者脑钠素(BNP)、血管紧张素Ⅱ(AngⅡ)的变化及氯沙坦的治疗价值。方法:入选患者分为阵发性房颤组(房颤组)40例,窦性心律组(对照组)40例。房颤组按治疗方法的不同又分为2亚组,A亚组服用胺碘酮及氯沙坦,B亚组单纯服用胺碘酮;对照组患者行原发病治疗。分别检测房颤组和对照组治疗前及房颤组的A、B亚组治疗后24个月的血浆肾素(PRA)、AngⅡ、BNP水平及平均左心房内径(LAD),进行对照分析。结果:①房颤组BNP、PRA、AngⅡ水平及LAD较对照组增加(P<0.05);②房颤组血BNP水平与LAD、AngⅡ浓度明显相关(r分别为0.362,0.294,P<0.05)。③房颤组治疗后A亚组较B亚组BNP水平降低(P<0.05),PRA、AngⅡ水平升高(P<0.05)。④氯沙坦干预能提高窦律维持率(P<0.05),可降低47%的房颤复发危险(RR=0.45,95%CI0.260~0.749,P<0.05)。结论:阵发性房颤患者BNP水平的升高可能与心房重构有关,氯沙坦可通过干预房颤的心房重构降低BNP水平并降低阵发性房颤的复发。
Objective: To investigate the changes of brain natriuretic peptide (BNP) and angiotensin Ⅱ (Ang Ⅱ) in patients with paroxysmal atrial fibrillation (AF) and the therapeutic value of losartan. Methods: The patients were divided into paroxysmal atrial fibrillation group (AF group) 40 cases, sinus rhythm group (control group) 40 cases. Atrial fibrillation group according to the different treatment methods are divided into 2 subgroups, A subgroup taking amiodarone and losartan, B subgroups simply taking amiodarone; control group patients with primary disease treatment. The levels of plasma renin (PRA), AngⅡ, BNP and mean left atrium diameter (LAD) were measured at 24 months after treatment in group A and group B before and after atrial fibrillation. Results: ①The levels of BNP, PRA, AngⅡ and LAD in AF group were significantly higher than those in control group (P <0.05); ② The level of serum BNP was significantly correlated with the concentrations of LAD and AngⅡ in AF group (r = 0.362,0.294, P <0.05) . ③ After treatment, the BNP level in A group was lower than that in B group (P <0.05), and the levels of PRA and AngⅡ were increased in AF group (P <0.05). ④ Losartan intervention can improve the maintenance of sinus rhythm (P <0.05), reduce the risk of recurrence of atrial fibrillation by 47% (RR = 0.45, 95% CI0.260 ~ 0.749, P <0.05). CONCLUSIONS: Elevated BNP levels in patients with paroxysmal atrial fibrillation may be related to atrial remodeling. Losartan may reduce BNP levels and reduce the recurrence of paroxysmal atrial fibrillation by atrial remodeling in atrial fibrillation.