怱朳嵶摦傪弰傞嵟嬤偺榖戣
帬夑堛壢戝妛 撪壢妛島嵗(屇媧婍丒弞娐婍撪壢)杧峕丂柅
偼偠傔偵
丂怱朳嵶摦偼丄怱朳嵶摦偼怱憻昦偺僄儞僪僗僥乕僕偲傕峫偊傜傟傞怱晄慡偵崌暪偡傞偙偲偑偁傝丄偦偺帯椕傪崲擄側傕偺偵偟傑偡丅傑偨丄怱朳嵶摦帺懱偑怱晄慡偺尨場偲側傞側偳丄傗偭偐偄側昦懺偱偡丅壛楊偲嫟偵憹壛偟丄擔忢恌椕偱傕偭偲傕昿斏偵傒傜傟傞晄惍柆偱偡丅暷崙偺摑寁偱偼丄怱朳嵶摦偺滊姵棪偼60嵨埲忋偱25恖偵侾恖丄80嵨埲忋偱偼10恖偵侾恖偲偝傟丄傑偨丄杮朚偱偼丄戝嶃戝妛丒杧愭惗偺傾儞働乕僩挷嵏偵傛傞奣嶼偱偼丄100枩恖丄柍徢忬幰傪擖傟傞偲150枩恖偵傕側傞偲悇掕偝傟偰偄傑偡丅
丂恾侾偵帵偡丄2000擭搙偺岤惗楯摥徣偺挷嵏偱偼丄70嵨埲忋偺擔杮恖抝惈偺4亾埲忋偑怱朳嵶摦偵滊姵偟偰偄偨偲偺偙偲偱偡丅偙偺傛偆偵悇掕偝傟傞滊姵幰悢偼帬夑導偺恖岥偵傎傏旵揋偟丄傎偐偺弞娐婍幘姵偲偔傜傋偰傕寛偟偰彮側偔偁傝傑偣傫丅偝傜偵丄怱朳嵶摦偼丄擼寣娗忈奞偺10乣20亾偵崌暪偟丄媡偵廳徢偺擼峓嵡偼丄怱朳嵶摦偵敽偆寣愷偺尨場偡傞丄偄傢備傞怱尮惈峓嵡偱偁傞偙偲傕栤戣偲側偭偰偍傝傑偡丅偡偙偟丄媽暦偵懏偟傑偡偑丄桳柤側尦栰媴娔撀偑丄怱朳嵶摦偵傛傞擼峓嵡傪婲偙偟偨僯儏乕僗偼峀偔儅僗僐儈庢傝忋偘傜傟傑偟偨丅
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| 恾1丂擔杮偵墬偗傞怱朳嵶摦偺滊姵棪丅廲幉偼亾偱墶幉偼擭楊偱偁傞丅 乮戞4師弞娐婍幘姵婎慴挷嵏傛傝嶌恾乯 |
儗僯儞丒傾儞僊僆僥儞僔儞丒傾儖僪僗僥儘儞(renin-angiotensin-aldosterone: RAA宯梷惂偼怱晄慡偵偍偗傞僗僞儞僟乕僪帯椕
丂偙偺傛偆偵怱朳嵶摦偲擼寣娗忈奞丄怱晄慡偼愗偭偰傕愗傟側偄娭楢偑偁傝傑偡偑丄怱晄慡帯椕偼丄嶐崱丄媫懍側恑曕傪尒偣偰偄傑偡丅RAA宯偺梷惂偑怱晄慡偺尨場偲側傞嵍怱幒偺儕儌僨儕儞僌傪梊杊偟丄傂偄偰偼怱晄慡姵幰偺惗柦梊屻傪夵慞偡傞偙偲偑丄懡偔偺椪彴帯尡偐傜帵偝傟偰偄傑偡丅側偐偱傕丄ARB (Angiotensin Receptor Blocker)偼丄angiotensin 1 receptor傪慖戰揑偵慾奞偡傞偙偲偵傛傝丄angiotensinII (Ang II)偺final common pathway傪抐偪愗傝丄傛傝愗傟枴偺傛偄儕儌僨儕儞僌慾巭嶌梡偑偁傝傑偡丅ACEI (angiotensin converting enzyme inhibitor)偱偼慾奞偝傟側偄僉儅乕僛宯傪夘偟偨AngII偺娭梌偑帵嵈偝傟傑偡丅
丂傑偨丄姰慡側RAA宯偺慾奞傪栚巜偡偵偼丄僔僌僫儖揱払偺傛傝壓棳偱偁傝丄怱嬝儕儌僨儕儞僌偵傛傝捈嵸揑偵摥偔angiotensin 1 (AT1) receptor傪慾奞偡傞偙偲偑棟偵偐側偭偰偄傑偡丅Ang II偺庴梕懱偵偼丄AT侾偲AT2偑偁傝傑偡偑丄奺庬僲僢僋傾僂僩儅僂僗偺幚尡偐傜丄AT1偲AT2庴梕懱傪夘偡傞斀墳偼憡斀偡傞偙偲丄AT侾庴梕懱偑怱嬝旍戝偵摥偔偺偵懳偟AT2庴梕懱偼丄偙傟偵漢峈揑偵嶌梡偡傞偙偲傕傢偐偭偰偒傑偟偨丅偟偨偑偭偰ACEI偵傛傞AngII崌惉偺慾奞偱偼丄曐岇揑偵摥偔AT2庴梕懱傕梷惂偟偰偟傑偆偙偲偵側傝傑偡丅
丂嵟嬤偵側偭偰丄ARB偺枬惈怱晄慡偵偍偗傞ARB偼彮側偔偲傕ACEI偲摨摍偺帯椕岠壥傪嫇偘傞偙偲偑丄Val-HeFT (Valsarta Heart Failure Trial)帋尡傗CHARM (Candesartan in Heart Failure Assessment in Mortality and Morbidity)帋尡偱徹柧偝傟傑偟偨丅偝傜偵丄2003擭偵側偭偰丄峓嵡屻偺怱幒儕儌僨儕儞僌偵娭偟偰傕丄ARB偑ACEI乮僇僾僩儕儖乯偲摨摍側梷惂嶌梡傪偙偲偑曬崘偝傟傑偟偨乮VALIANT帋尡乯丅偡側傢偪丄媫惈怱嬝峓嵡屻偺姵幰偵搳梌偝傟偨僶儖僒儖僞儞偼丄憤巰朣偲怱僀儀儞僩敪徢傪桳堄偵尭彮偟傑偟偨丅偙偺傛偆偵ACEI偺傒側傜偢ARB偵傛傞RAA宯梷惂偼怱晄慡偵偍偗傞僗僞儞僟乕僪帯椕偲側傝偮偮偁傝傑偡丅偙偺傛偆側忬嫷傪摜傑偊偰丄杮朚偱奐敪偝傟偨僇儞僨僒儖僞儞偼丄嶐擭丄枬惈怱晄慡偵揔墳傪偲偭偰偄傑偡丅
RAA宯偲怱朳嵶摦
丂偝偰丄Ang II偺憻婍忈奞偼懡婒偵傢偨傝傑偡偑丄嵟嬤丄怱憻偵偍偄偰傕怱幒偺傒側傜偢怱朳嬝偱傕丄怱嬝偺恑揥乮stretch乯傪僩儕僈乕偲偟偰丄怱朳慻怐偺RAA宯偑妶惈壔偝傟偦偺慄堐壔偑懀恑偝傟傞偙偲偑帵偝傟傑偟偨丅師偄偱丄偙傟偼怱嬝偺揱摫晄嬒堦傪婲偙偟偰丄怱朳嵶摦偑堐帩偝傟傞夝朥妛揑側慺抧傪梌偊傞偙偲偵側傝傑偡乮夝朥妛揑側怱朳儕儌僨儕儞僌1乯丗恾2乯丅怱朳嵶摦偼丄偄偭偨傫丄敪徢偡傞偲宱夁偲嫟偵丄偦偺帩懕帪娫偑挿偔側傝嵟屻偵偼峆媣壔偟傑偡偑丄偙偺尰徾傪Allessie傜2乯偼丄Atrial fibrillation begets atrial fibrillation乮怱朳嵶摦偼怴偨側怱朳嵶摦傪惗傓乯偲昞尰偟丄抁帪娫偱傕偙偺晄惍柆偵尒晳傢傟偨怱朳偱偼丄晄墳婜偑桳堄偵抁弅偡傞偙偲偵傛傝揹婥揑偵怱朳嵶摦偑堐帩偝傟堈偔側傞偙偲傪曬崘偟傑偟偨丅偙偺尰徾偼丄抁婜偺electrical remodeling乮揹婥揑儕儌僨儕儞僌乯偲柦柤偝傟傑偟偨乮恾2乯丅
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| 恾2丂怱朳嵶摦傪堐帩偡傞偨傔偺怱朳儕儌僨儕儞僌丅3偮偺埆惈僒僀僋儖丅 Allessie et al. Cardiovascular Research榑暥乮2002乯傛傝堷梡丅 |
丂偙偺尰徾偵偮偄偰偼宑墳戝妛偺愭惗曽偺嫽枴怺偄専摙3乯偑偁傝傑偡丅恾3偵帵偟傑偡偑丄帩懕惈怱朳嵶摦偱揹婥彍嵶摦傪巤峴偟偨15椺偱丄彍嵶摦捈屻偲24帪娫屻偵2搙揹婥惗棟専嵏傪峴偭偰怱朳嬝偺晄墳婜傪應掕偝傟偰偄傑偡丅懡偔偺椺偱彍嵶摦捈屻傛傝24帪娫屻偺曽偑晄墳婜偼墑挿偟偰偍傝丄媡偵偄偆偲怱朳嵶摦偵傛傝晄墳婜偼抁弅偡傞偙偲偑暘偐傞傢偗偱偡偑丄偦偺抁弅偺掱搙偁傞偄偼彍嵶摦屻偺24帪娫偺娫偵墑挿偡傞搙崌偄偼丄怱朳嵶摦偺帩懕帪娫偑抁偄傎偆偑丄傛傝戝偒偄偙偲偑帵偝傟傑偟偨丅偡側傢偪丄揹婥揑儕儌僨儕儞僌偼抁婜偺怱朳嵶摦偱偼彍嵶摦偵傛傝夵慞偡傞乮reverse remodeling乯偲峫偊傜傟傑偡丅
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| 恾3丂怱朳嵶摦偺帩懕帪娫偲怱朳嬝偺晄墳婜偺娭學丅 偡傋偰偺僌儔僼偺墶幉偼15柤偺怱朳嵶摦偺帩懕婜娫傪懳悢僾儘僢僩偟偰偄傞丅 廲幉偼丄嵍恾偱偼丄彍嵶摦屻丄侾帪娫偺怱朳晄墳婜丄拞墰偼24帪娫屻偺怱朳晄墳婜偱丄 塃恾偱偼丄侾帪娫屻偲24帪娫屻偺晄墳婜偺嵎偱偁傞丅 懡偔偺徢椺偱墑挿偡傞偨傔偙偺嵎偼惓偺抣傪偲傞偑丄怱朳嵶摦帩懕帪娫偺抁偄徢椺偺傎偆偑丄 傛傝戝偒偔墑挿偡傞丅 |
丂3偮栚偺怱朳嵶摦傪堐帩偡傞儕儌僨儕儞僌場巕偲偟偰廂弅惈偺栤戣偑偁傝傑偡丅慜弎偺揹婥揑儕儌僨儕儞僌偑婲偙傝傑偡偲丄晄墳婜偑抁弅偟偰L宆僇儖僔僂儉僠儍僱儖偺down-regulation偑婲偙偭偰丄偙偺僠儍僱儖傪夘偟偰嵶朎撪偵棳擖偡傞僇儖僔僂儉丒僀僆儞偑尭彮偟傑偡丅偦偺寢壥丄怱朳偺廂弅椡偑掅壓偟丄偝傜偵怱朳偼奼戝偟傑偡丅偙傟偼丄怱朳嬝偺慄堐壔傗揹婥揑摿惈偺曄壔偲崌傢偝偭偰丄怱朳嵶摦偺廳徢壔丒枬惈壔偵摥偒傑偡乮恾2乯丅
丂嵟嬤丄偙偺傛偆側怱朳儕儌僨儕儞僌傪慾巭偡傞upstream帯椕栻偲偟偰ARB偑拲栚偝傟偰偄傑偡丅恾4偵柾幃揑偵尰帪揰偱偺怱朳嵶摦偺帯椕朄傪帵偟傑偡偑丄廬棃偺峈晄惍柆栻傗兝僽儘僢僇乕偑丄尰偵婲偙偭偰偄傞晄惍柆傪掆巭偟偨傝丄偦偺徢忬傪寉尭偡傞丄偄傢備傞downstream帯椕栻偱偁傞偺偵懳偟偰ARB偼晄惍柆偺尨場偲側傞慺抧乮substrate乯偺敪惗傪梊杊偡傞丄偄傢備傞upstream帯椕栻偲側傝摼傑偡丅
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| 恾4 |
丂嵟弶偵丄ARB偑怱朳嵶摦偺嵞敪梊杊偵摥偔偙偲傪帵偟偨偺偼丄僗儁僀儞偺Madrid傜4乯偱偡乮恾5乯丅偐傟傜偼丄怱朳嵶摦偺彍嵶摦屻偺嵞敪梊杊栻偲偟偰丄儓乕儘僢僷偱峀偔巊梡偝傟偰偄傞傾儈僆僟儘儞偲偙傟偵壛偊偰ARB偺僀儖儀僒儖僞儞傪搳梌偡傞2孮偵暘偗偰丄嵞敪棪傪娤嶡偟偰偄傑偡丅嫽枴怺偄偙偲偵丄暪梡孮偵偍偄偰桳堄偵嵞敪偑彮側偔丄偝傜偵丄偦偺岠壥偼丄彍嵶摦屻偺悢廡娫偱尠挊偱偡丅
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| 恾5丂僀儖儀僒儖僞儞偺怱朳嵶摦偺嵞敪梷惂岠壥丅 Madrid et al偺Circulation榑暥乮2002擭乯傛傝夵曄丅 |
丂偙偙偱丄Allessie愭惗偺恾2偵帵偟偨怱朳嵶摦偵偍偗傞怱朳儕儌僨儕儞僌偺峫偊曽偵栠傝偨偄偺偱偡偑丄廬棃丄RAA宯偺慾奞偵傛傝怱朳偺峔憿揑側儕儌僨儕儞僌偑梷惂偝傟丄寢壥偲偟偰怱朳嵶摦偺嵞敪偑梷偊傜傟傞偲懡偔偺幚尡偱曬崘偝傟偰偄傑偟偨丅偟偐偟丄Madrid傜偺抦尒乮恾5乯偱偼丄ARB搳梌徢椺偱偼傾儈僆僟儘儞扨撈搳梌椺偵斾傋偰丄旕忢偵憗婜偺乮2乣4廡乯怱朳嵶摦嵞敪傪梷惂偟偰偄傑偡丅偙偺偙偲偼丄ARB偑怱朳嵶摦敪徢偺弶婜偐傜婲偙傞怱朳偺揹婥揑儕儌僨儕儞僌乮恾2乯偺梷惂偵傕娭梌偟偰偄傞壜擻惈偑偁傝傑偡丅揹婥惗棟妛揑側曽朄傪梡偄偰丄傢傟傢傟偼丄偙偺揰偵偮偄偰専摙偟偰傒傑偟偨丅
AngII偼怱朳嬝偺K僠儍僱儖傪妶惈壔偡傞偙偲偵傛傝丄偦偺晄墳婜傪抁弅偟怱朳嵶摦偺揹婥揑儕儌僨儕儞僌傪懀恑偡傞
丂儌儖儌僢僩怱朳嬝嵶朎偵丄AngII傪搳梌偡傞偲丄怱朳嬝偺抶墑惍棳K僠儍僱儖傪妶惈偟丄偦偺寢壥丄怱朳偺妶摦揹埵傪抁弅偡傞偙偲偑娤嶡偝傟傑偟偨5乯乮恾6乯丅晄巚媍側偙偲偵丄偙偺傛偆側K僠儍僱儖偺妶惈壔偼怱幒嬝嵶朎偱偼擣傔傜傟傑偣傫偱偟偨丅偙偺偙偲偼丄怱朳偱AngII偺儗儀儖偑憹壛偡傞偲丄偦偺晄墳婜偑抁弅偟怱朳嵶摦傪堐帩偡傞傛偆偵摥偔偙偲傪堄枴偟傑偡丅偟偨偑偭偰丄ARB偼丄偙偺忣曬揱払婡峔傪慾奞偡傞偙偲偱丄怱朳偺揹婥揑儕儌僨儕儞僌傪梷偊偰丄怱朳嵶摦偺嵞敪傪梊杊偡傞偲峫偊傜傟傑偡丅巻柺悢偺娭學偱丄偦偺撪梕傪徻嵶偵徯夘偱偒傑偣傫偑丄嫽枴偺偁傞曽偼惀旕傢偨偔偟偳傕偺榑暥乮壓偵堷梡乯傪偍撉傒偔偩偝偄丅
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| 恾6丂儌儖儌僢僩怱朳嬝嵶朎偵揹棳屌掕傪峴偄妶摦揹埵傪婰榐偟偰偄傞丅 AngII 100 nM偺搳梌偵傛傝妶摦揹埵偼挊偟偔抁弅偟丄washout偵傛傝尦偵栠傞偺偑暘偐傞丅 懡偔偺嵶朎偱偙傟傪妋擣偟僶乕僌儔僼偵傑偲傔偨偺偑塃偺恾偱偁傞丅 |
偍傢傝偵
丂怱朳嵶摦姵幰偺30亾偵崅寣埑徢偑崌暪偡傞偲尵傢傟偰偄傑偡丅偡側傢偪丄崅寣埑偺姵幰偼怱朳嵶摦偺廳梫側梊旛孯偱偡丅恾7偵丄傢偨偔偟偺怱朳嵶摦帯椕偵娭傢傞僐儞僙僾僩傪帵偟傑偡丅敪徢偡傞慜偐傜丄儕僗僋僼傽僋僞乕傪帯椕偡傞ARB偺搳梌偼怱朳嵶摦偺upstream帯椕偲偄偆偙偲偑偱偒傑偡丅
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恾7丂怱朳嵶摦偺昦婜僗僥乕僕暘椶偲帯椕 |
暥丂專
1) Li D, Shinagawa K, Pang L, Leung TK, Cardin S, Wang Z, Nattel S. Effects of angiotensin-converting enzyme inhibition on the development of the atrial fibrillation substrate in dogs with ventricular tachypacing-induced congestive heart failure. Circulation. 104: 2608-2614, 2001
2) Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 54: 230-246, 2002
3) Sato T, Mitamura H, Kurita Y, Takeshita A, Shinagawa K, Miyoshi S, Kanki H, Hara M, Takatsuki S, Soejima K, Ogawa S. Recovery of electrophysiological parameters after conversion of atrial fibrillation. Int J Cardiol. 79: 183-189, 2001
4) Madrid AH, Bueno MG, Rebollo JM, Marin I, Pena G, Bernal E, Rodriguez A, Cano L, Cano JM, Cabeza P, Moro C. Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: a prospective and randomized study. Circulation 106: 331-336, 2002
5) Zankov DP, Toyoda F, Ding W-G, Matsuura H, Horie M. Angiotensin II potentiates IKs potassium current via AT1 receptors in guinea-pig atrial myocytes. Circulation 133: 1278-1286, 2006
Correspondence:丂帬夑堛壢戝妛撪壢妛島嵗丂杧峕丂柅丂丂仹520-2192丂戝捗巗悾揷寧椫挰