论文部分内容阅读
目的动脉壁细胞外基质的合成和降解紊乱是动脉粥样硬化过程的主要特征。本研究观察3种抗高血压方案下,达到同等血压控制后,循环前胶原更新标志物——Ⅲ型胶原氨基端肽(PⅢNP)的改变和血管阻力的改变。方法轻中度原发性高血压患者130例,随机分为三组,依那普利+螺内酯组(A组,44例,螺内酯20mg/d)、依那普利组(B组,43例)、非直接肾素-血管紧张素-醛固酮系统干预治疗组(C组,43例,β受体阻断剂或钙拮抗剂),观察1年,目标血压<130/80mmHg(1mmHg=0.133kPa)。比较三种治疗方案对心肌胶原更新和外周血管阻力的影响。结果各组均同等有效控制血压,在此前提下,减低血清PⅢNP的疗效[A组(2.3±0.2)μg/L比(3.8±0.2)μg/L,P<0.05;B组(3.4±0.3)μg/L比(3.7±0.3)μg/L,P>0.05;C组(3.9±2.0)μg/L比(3.2±1.5)μg/L,P<0.05]和减低血管阻力[A组(1064.3±158.6)dyn.s-1.cm-5比(1358.3±212.5)dyn.s-1.cm-5;B组(1200.8±298.7)dyn.s-1.cm-5比(1394.0±181.0)dyn.s-1.cm-5;C组(1205.1±206.4)dyn.s-1.cm-5比(1579.9±574.7)dyn.s-1.cm-5,P均<0.05],治疗效果A组优于B组,A、B两组均优于C组。结论螺内酯联合依那普利治疗比单纯依那普利治疗更好地减低血清PⅢNP,使心血管系统间质胶原沉积明显减低,并使血管阻力和顺应性改善,而且该作用不依赖于血压下降。两组均优于非直接肾素-血管紧张素-醛固酮系统干预治疗。
Purpose The synthesis and degradation of the extracellular matrix of the arterial wall are the major hallmarks of the atherosclerotic process. This study was designed to observe the change of vascular collagen Ⅲ (PⅢNP) and the change of vascular resistance in the three antihypertensive regimens after achieving the same blood pressure control. Methods 130 patients with mild to moderate essential hypertension were randomly divided into three groups: enalapril plus spironolactone (group A, n = 44, spironolactone 20 mg / d), enalapril (group B, n = 43 ), Non-direct renin-angiotensin-aldosterone system intervention group (group C, 43 patients, β-blockers or calcium antagonists), observed for 1 year, the target blood pressure <130/80 mmHg (1mmHg = 0.133kPa ). The effects of three treatment regimens on myocardial collagen renewal and peripheral vascular resistance were compared. Results The blood pressure was equally controlled in all groups, and the effect of serum PⅢNP was reduced [(2.3 ± 0.2) μg / L vs 3.8 ± 0.2 μg / L, P <0.05 in group A and 3.4 ± 0.3 (3.7 ± 0.3) μg / L, P> 0.05; C group (3.9 ± 2.0) μg / L vs (3.2 ± 1.5) μg / L, P <0.05] 1064.3 ± 158.6) dyn.s-1.cm-5 (1358.3 ± 212.5) dyn.s-1.cm-5, and group B (1200.8 ± 298.7) dyn.s-1.cm- ) dyn.s-1.cm-5; C group (1205.1 ± 206.4) dyn.s-1.cm-5 ratio (1579.9 ± 574.7) dyn.s-1.cm- The effect of group A was better than group B, while group A and B were better than group C. Conclusion Spironolactone combined with enalapril treatment can reduce serum PⅢNP better than enalapril alone and significantly reduce collagen deposition in cardiovascular system interstitium and improve vascular resistance and compliance, and this effect does not depend on the decrease of blood pressure . Both groups were superior to the non-direct renin-angiotensin-aldosterone system intervention.