氯沙坦对老年冠心病患者EPCs动员作用及改善血管内皮功能机制研究.docVIP

氯沙坦对老年冠心病患者EPCs动员作用及改善血管内皮功能机制研究 　　[摘要] 目的 探讨氯沙坦对老年冠心病患者内皮祖细胞（EPCs）的动员作用及改善血管内皮功能的机制。方法 选取老年冠心病患者65例，随机分为对照组 32例 和观察组 33例 ，分别给予常规药物和常规药物+氯沙坦治疗，检测治疗前后血EPCs及NO和内皮素-1（ET-1）。 结果 治疗后观察组EPCs及NO水平高于对照组（P0.05），ET-1明显低于对照组（P0.01）。观察组氯沙坦治疗后EPCs与NO呈现正相关（r=0.421， P=0.014），与ET-1呈现负相关（r=-0.398， P=0.021）。结论 氯沙坦能够改善老年冠心病患者内皮功能，其作用机制可能是通过对EPCs的动员作用而发挥功能。 　　[关键词] 氯沙坦；内皮祖细胞；冠心病；内皮功能；一氧化氮 　　[中图分类号] R541.4 [文献标识码] B [文章编号] 1673-9701（2014）27-0030-03 　　[Abstract] Objective To study effects of losartan on the mobilization of EPCs and its mechanism of improving endothelial function in elderly patients with coronary heart disease. Methods A total of 65 elderly patients with coronary heart disease were randomly divided into control group （32 cases） and observation group （33 cases）， the former were given conventional medicine and the latter conventional medicine with losartan. The EPCs ， NO and endothelin-1（ET-1） were detected before and after treatment. Results There was no difference between the two groups before treatment in general information （P0.05）； After treatment， EPCs and NO in observation group were statistically higher than that in the control group（P0.05）， but ET-1 was significantly lower than the control group（P0.01）. EPCs and NO were positively correlated in observation group（r=0.421， P=0.014）； EPCs and ET-1 showed a significant negative correlation （r=-0.398， P=0.021）. Conclusion Losartan can improve the function of vascular endothelial in elderly patients with coronary heart disease， and it may be achieve this goal through the mobilization of EPCs. 　　[Key words] Losartan； Endothelial progenitor cells； Coronary heart disease； Endothelial function； Nitric oxide 　　冠心病是由于冠状动脉粥样硬化致冠脉狭窄、阻塞致心肌缺血缺氧或坏死而引起的心脏病，损伤应答学说认为内皮细胞的损伤是其发病的始动环节。冠心病在老年人中发病率特别高，这与老年人血管老化、内皮功能减退有关。近年来国内外研究表明，由骨髓释放入外周的循环内皮祖细胞（endothelial progenitor cells，EPCs）可以自我更新、增殖、迁移、黏附于受损内皮处并分化为成熟的内皮细胞，从而修复损伤的血管内皮。冠心病患者外周血液中EPCs不仅数量减少，同时伴有增殖及分化成熟功能的减退[1]，鉴于EPCs的重要作用，针对EPCs水平和功能的调控成为冠心病药物治疗的新靶点[2]。研究证实，血管紧张素Ⅱ受体（AT1受体）拮抗药A