2021 年第 1 期 第 16 卷

华法林与利伐沙班对心房颤动患者经导管主动脉瓣置换术后心功能及血管内皮功能影响的对比研究

Comparative study of warfarin and rivaroxaban on cardiac function and vascular endothelial function in patients with atrial fibrillation after transcatheter aortic valve replacement

作者：陈东琳

英文作者：Chen Donglin

单位：广西医科大学第一附属医院老年心内科,南宁530021 

英文单位：Department of Geriatric Cardiology the First Affiliated Hospital of Guangxi Medical University Nanning 530021 

关键词：心房颤动；经导管主动脉瓣置换；利伐沙班；华法林 

英文关键词：Atrialfibrillation;Transcatheteraorticvalvereplacement;Rivaroxaban;Warfarin

• 摘要：

• 目的 比较华法林与利伐沙班对心房颤动患者行经导管主动脉瓣置换（TAVR）术后心功能和血管内皮功能的影响。方法 选取2016年3月至2019年3月广西医科大学第一附属医院收治的接受TAVR手术治疗的心房颤动患者50例，根据随机数字表法分为对照组和观察组，各25例。对照组TAVR术后给予华法林进行抗凝治疗；观察组TAVR术后给予利伐沙班进行抗凝治疗，平均随访12个月。比较2组疗效和治疗前后左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、内皮素1、一氧化氮、血管细胞黏附分子1（VCAM-1）、细胞间黏附分子1（ICAM-1）水平。结果 观察组总有效率明显高于对照组［92.0%（23/25）比68.0%（17/25）］，差异有统计学意义（P=0.023）。治疗后，观察组LVEF、一氧化氮水平明显高于对照组，LVEDV、LVESV、内皮素1、VCAM-1、ICAM-1水平均明显低于对照组，差异均有统计学意义（均P＜0.05）。结论 与华法林相比，利伐沙班能显著改善心房颤动患者TAVR术后的心功能，促进心脏功能恢复，保护血管内皮功能。

• Objective To compare the effect of warfarin and rivaroxaban on cardiac function and vascular endothelial function in patients with atrial fibrillation after transcatheter aortic valve replacement (TAVR). Methods Fifty patients with atrial fibrillation and underwent TAVR in the First Affiliated Hospital of Guangxi Medical University from March 2016 to March 2019 were selected, and they were randomly divided into control group and observation group, with 25 cases in each group. The control group was given warfarin for anticoagulant therapy after TAVR, and the observation group was given rivaroxaban for anticoagulant therapy after TAVR, with an average followed-up of 12 months. The curative efficacy and the levels of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), endothelin-1, nitric oxide, vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) were compared between the two groups before and after treatment. Results The total effective rate of the observation group was significantly higher than that of the control group ［92.0%(23/25) vs 68.0%(17/25)］(P=0.023). After treatment, the levels of LVEF and nitric oxide in the observation group were significantly higher than those in the control group, while the levels of LVEDV, LVESV, endothelin-1, VCAM-1 and ICAM-1 in the observation group were significantly lower than those in the control group (all P＜0.05). Conclusion Compared with warfarin, rivaroxaban can significantly improve the cardiac function, promote the recovery of cardiac function and protect the function of vascular endothelium of patients with atrial fibrillation after TAVR.