摘要
目的了解原发性高血压（EH）不同合并症患者血浆内皮素（ET）浓度的变化及辛伐他汀干预对其影响。方法入选EH患者149例，根据合并症的不同分为单纯EH组44例，EH合并左心室肥厚（EH—LVH）组40例，EH合并心房颤动（EH—AF）组36例，EH合并腔隙性脑梗死（EH-LI）组29例，同时选择30例健康体检者作为对照。149例EH患者按血压水平随机分为常规治疗组（主要应用钙拮抗剂、血管紧张素转换酶抑制剂、利尿剂、B受体阻滞剂等药治疗8周）和辛伐他汀干预组（常规治疗＋辛伐他汀40mg／d），药物治疗前后检测血浆内皮素。结果（1）EH组ET浓度高于对照组[（71．42±6．62）pg/ml对（45．52±8．28）pg/ml，P〈0．01]并与血压升高程度呈正相关（r=0．746，P〈0．001），EH—LVH组、EH—AF组、EH—LI组ET浓度均高于EH组[（97．67±10．53）pg／ml、（102．15±12．96）pg/ml、（103．49±9．91）pg/ml对（71．42±6．62）pg／ml，P〈0．01]，ET浓度变化均与血压升高程度呈正相关（r=0．671，r=0．592，r=0．530，P均〈0．001）。（2）EH-AF组左心房内径与ET浓度呈正相关（r=0．684，P〈0．001）；EH—LVH组的左心室质量指数与ET浓度呈正相关（r=0．545，P〈0．001）。（3）EH—LVH组、EH—AF组、EH-LI组的3级高血压所占的百分比均高于EH组。（4）EH3级辛伐他汀干预组治疗后血压水平较常规治疗组下降更为显著（P〈0．05）。（5）EH2级辛伐他汀干预组治疗后ET水平较常规治疗组显著降低（P〈0．05），EH3级辛伐他汀干预组和常规治疗组治疗后ET水平均显著降低（P〈0．05），但辛伐他汀干预组下降更为显著（P〈0．05）。结论ET水平与EH的严重程度呈正相关，辛伐他汀干预能更显著降低EH患者ET水平和EH3级患者的血压，提示对EH患者在使用降压药物控制血压的同时合用他汀类药物可能更有益。
Objective To observe the association between plasma endothelin （ET） concentration and blood pressure level in essential hypertensive （EH）patients with or without complications and possible impact of statins on ET concentration. Methods From Sep 2007 to Mar 2009, 149 patients with EH were analyzed [ 44 EH, 40 EH complicated by left ventricular hypertrophy （EH-LVH）, 36 EH complicated by atrial fibrillation （EH-AF）, and 29 EH complicated by lacunar infarction （EH-LI）], 30 healthy persons were selected as controls. EH patients were randomly divided into routine treatment group （calcium antagonists, ACEI, diuretics, β-receptor blocker for 8 weeks） and simvastatin intervention group （ routine treatment ＋ simvastatin 40 mg/d for 8 weeks）, plasma ET concentrations before and after drug intervention were measured. Results （ 1 ） ET concentration was higher in EH group than that in control group [ （71.42 ＋ 6. 62 ） pg/ml vs. （45.52 ＋ 8. 28 ） pg/ml, P 〈 0. 01 ]. ET concentration was higher in EH-LVH group, EH- AF group and EH-LI group than that in EH group [ （97.67 ± 10. 53） pg/ml, （ 102. 15 ± 12. 96） pg/ml, （ 103.49 ± 9. 91 ）pg/ml vs. （71.42 ＋ 6. 62） pg/ml, P 〈 0. 01 ]. The degrees of elevated blood pressure was positively correlated with ET concentrations （all P 〈 0. 001 ）. （2） The left atrial diameters of EH-AF group were positively correlated with ET concentration （ r = 0. 684, P 〈 0. 001 ）. The left ventricular mass index of EH-LVH group were positively correlated with ET concentration（ r = 0. 545, P 〈 0. 001 ）. （ 3 ） The percentages of class 3 hypertension in EH-LVH group, EH-AF group and EH-LI group were higher than that in EH group （57. 5% ,50. 0% ,62. 1% vs. 25. 0% ,all P 〈0. 05）. （4） Blood pressure in class 3 hypertension patient treated with simvastatin decreased more significantly than that in routine treatment group（P 〈 0. 05 ）. （5）ET concentration of class 2 hypertension patient treated with simvastatin decreased significantly than that in routine treatment group（ P 〈 0. 05 ）. ET concentrations of class 3 hypertension patient treated with simvastatin and routine treatment patient decreased significantly after treatment （ P 〈 0. 05 ）, and the former was lower （P 〈 0. 05）. Conclusion The level of ET were positively correlated with the severity of EH. Simvastatin could decrease the ET levels of patients with EH and blood pressure levels of patients with class 3 hypertension. It suggested that therapeutic alliance of antihypertensive drugs and statins could be benefit to patients with EH.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2009年第9期800-803,共4页
Chinese Journal of Cardiology
关键词
高血压
内皮素
辛伐他汀
Hypertension
Endothelin
Simvastatin
