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目的:研究卡维地洛预防阵发性心房颤动(PAF)复发的疗效及安全性,以促进其安全合理应用。方法:本研究为前瞻、随机、平行、对照研究,入选PAF患者53例,分为2组:卡维地洛(CAV)组27例和美托洛尔(MET)组26例,分别给予CAV25 mg/d和MET 50 mg/d,疗程1年。检测治疗前后外周血单个核细胞的MMP2、MMP9表达、静息心率(SHR)、左房内径(LAD)、左室舒张末内径(LVEDd)、左室射血分数(LVEF),并记录治疗1年内心房颤动(AF)复发情况,包括复发率、发作频率(OF)、发作持续时间(OST)、发作时心室率(OVR)。结果:⑴与治疗前比较,CAV、MET 2组LVEDd、LVEF均无显著变化(均P>0.05),2组SHR治疗前后分别为(68±12)次/m in,(61±9)次/m in和(69±11)次/m in,(61±11)次/m in,显著减慢(均P<0.05);CAV组LAD变化不显著(P>0.05),但MET组LAD显著升高(P<0.01);CAV组治疗前后MMP2、MMP9表达分别为(138.5±56.4)ng/d l与(103.7±49.5)ng/d l和(19.6±11.1)ng/d l与(11.3±9.4)ng/d l,显著降低(P<0.05,P<0.01),MET组MMP2、MMP9表达下降无显著性(P>0.05);CAV组OF明显下降(P<0.01),MET组OF无显著变化(P>0.05)。⑵治疗后2组比较,CAV组除LAD显著低于MET组外(P<0.01),其余心脏形态功能指标2组均无统计学差异(P<0.01,P>0.05);CAV组MMP2、MMP9表达及AF OF、OST也显著低于MET组(均P<0.05),2组AF复发率、OVR均无明显差别(均P>0.05)。⑶CAV及MET组,OF与LAD均呈正相关(r=0.826,P<0.01),与MMP2、MMP9表达也呈正相关(r=0.773,r=0.819,均P<0.01)。⑷CAV和MET 2组,均未出现严重的房室传导阻滞,2种药物对血糖未产生显著的影响。结论:CAV可安全有效地用于预防PAF复发。
Objective: To study the efficacy and safety of carvedilol in preventing recurrence of paroxysmal atrial fibrillation (PAF) in order to promote its safe and rational use. Methods: In this prospective, randomized, parallel and controlled study, 53 PAF patients were divided into 2 groups: 27 in CAV group and 26 in metoprolol group. CAV25 mg / d and MET 50 mg / d for 1 year. The levels of MMP2, MMP9, resting heart rate (SHR), left atrium diameter (LAD), left ventricular end-diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were measured before and after treatment. During the year, the recurrence of atrial fibrillation (AF), including the recurrence rate, the frequency of episodes (OF), the duration of the attack (OST) and the rate of the ventricular rate during the attack (OVR). Results: (1) There was no significant change in LVEDd and LVEF between CAV and MET 2 groups (all P> 0.05) before and after treatment, and (68 ± 12) times per minute and (61 ± 9) times before and after SHR treatment / m in and (69 ± 11) times / m in, and (61 ± 11) times / m in, all of which were significantly lower (all P <0.05); LAD did not change significantly in CAV group (P> 0.05) (138.5 ± 56.4) ng / dl and (103.7 ± 49.5) ng / dl and (19.6 ± 11.1) ng / dl and (11.3 ± 9.4), respectively, before and after treatment in CAV group (P <0.05, P <0.01). The expressions of MMP2 and MMP9 in MET group were not significantly decreased (P> 0.05), OF in CAV group was significantly decreased (P <0.01) (P> 0.05). (2) Compared with MET group, the LVEF in CAV group was significantly lower than that in MET group (P <0.01), and there was no significant difference in other cardiac function parameters between the two groups (P <0.01, P> 0.05) (P <0.05). There was no significant difference in AF recurrence rate and OVR between the two groups (all P> 0.05). There was a positive correlation between OF and LAD in CAV and MET groups (r = 0.826, P <0.01), and positive correlation with MMP2 and MMP9 (r = 0.773, r = 0.819, all P <0.01). ⑷CAV and MET 2 group, no serious atrioventricular block, two kinds of drugs on blood glucose did not produce a significant impact. Conclusion: CAV can be safely and effectively used to prevent PAF recurrence.