综合干预对高血压患者左室肥厚、冠状动脉钙化和动脉内皮功能的影响论文.docx

综合干预对高血压患者左室肥厚、冠状动脉钙化和动脉内皮功能的影响　作者：张志伟，林泽鹏，彭晓玲作者单位：国家“十一五”科技支撑课题(2006BA101A03)相关亚课题研究深圳市孙逸仙心血管医院心內科, 广东深圳 518020　　【摘要】目的：探讨联合降压治疗与适当调脂综合干预对原发性高血压患者内皮功能、左心室重构、冠状动脉粥样硬化的影响。方法：入选50～79岁原发性高血压200例，随机分为：A组(49例):使用小剂量氨氯地平(2.5 mg/d)+替米沙坦(40 mg/d)，B组(51例):使用小剂量氨氯地平+复方阿米洛利(复方利尿剂，半片/d)，C组(48例):在A组基础上加小剂量辛伐他汀(10mg/d)，D组(52例):在B组基础上加辛伐他汀(10mg/d)。A组及B组患者治疗12个月前后各检查一次超声心动图，C组及D组患者，测定治疗12个月前后血浆血管紧张素酶(ACE)活性、血管紧张素Ⅱ(AngⅡ)浓度、肱动脉内皮依赖性舒张功能(FMD)及冠状动脉斑块的变化情况。结果：(1)A组患者的左室后壁厚度[LVWPT,( 1.09±0.21) cm∶( 1.27±0.28) cm]与室间隔厚度[IVST,(1.09±0.27) cm∶( 1.28±0.31) cm]在治疗12月后较治疗前显著下降(P均0.05)，而左室重量[LVM,(205.23±62.04)g∶( 263.97±98.06)g]及左室重量指数[LVMI,( 128.13±34.15) g/m2∶( 164.98±60.33) g/m2]下降更显著(P均0.01);FMD明显改善[(5.6±4.2)%∶( 4.3±2.7)%,P0.05];(2)较之B组，A组的LVM[(225.23±72.8)g∶(205.23±62.04)g]，LVMI[(139.27±37.26) g/m2∶ ( 128.13±34.15) g/m2]下降更加显著，FMD[(4.8±3.7) %∶(5.6±4.2) %]提高更显著,P均0.05;(3)C组及D组患者用小剂量辛伐他汀治疗l2月后，血清TC、LDL-C、ACE活性、AngⅡ浓度、冠脉钙化积分对数值均显著下降(P均0.01),且分别较A组，B组显著下降(P0.05～0.01),但C、D两组无显著差异(P0.05)。结论：原发性高血压患者在小剂量氨氯地平+替米沙坦或复方阿米洛利治疗12月后可使左室肥厚显著逆转;对左室肥厚、动脉内皮功能的作用，替米沙坦优于复方阿米洛利;加用小剂量辛伐他汀可使冠脉钙化积分下降,有防治冠状动脉粥样硬化的作用。　　【关键词】高血压;冠状动脉硬化;内皮;肥大，左心室　　Influence of combination intervention on left ventricular remodeling, endothelial function and coronary atherosclerosis in hypertension patients/ZHANG Zhiwei, LIN Zepeng, PENG Xiaolin// Department of Cardiology, Sunyixian Cardiovascular Hospital, Shenzhen, Guangdon, 518020, China　　Abstract：Objective:To evaluate the influence of combination intervention on left ventricular remodeling, endothelial function, and coronary atherosclerosis in hypertension patients.Methods: A total of 200 essential hypertension(EH) patients were enrolled and randomly divided into four groups: A, B, C and D group. Patients in group A received low-dose amlodipine (2.5mg/d) and telmisartan (40mg/d), group B had low-dose amlodipine and compound amiloride (compound diuretic, half tablet/d), group C had simvastatin(10mg/d)above the treat base of groups A, while group D had simvastatin(10mg/d)above the