阿托伐他汀对高血压病早期肾损害患者MMP-9及TIMP-1的影响  

The Effects of Atorvastatin on MMP-9 and TIMP-1 in Essential Hypertension Patients with Early Renal Damage

作　　者：李慧颖[1] 李静[1] 

机构地区：[1]山东省医学科学院附属医院心内科,山东省济南市250031

出　　处：《中国动脉硬化杂志》2015年第6期607-612,共6页Chinese Journal of Arteriosclerosis

摘　　要：目的探讨阿托伐他汀对高血压病(EH)早期肾损害患者血清基质金属蛋白酶9(MMP-9)和组织金属蛋白酶抑制物1(TIMP-1)的影响,及MMP-9、TIMP-1与尿微量白蛋白(MAU)的关系。方法选择2012年1月至2013年9月在我院心内科门诊就诊的EH早期肾损害患者120例,随机分为美托洛尔+阿托伐他汀组60例和美托洛尔组60例。美托洛尔+阿托伐他汀组予阿托伐他汀口服,每晚10 mg,另加美托洛尔口服,每天25~100 mg;美托洛尔组口服美托洛尔,每天25~100 mg。以坐位血压<140/90 mm Hg为目标血压来调整降压药物剂量,未达标者加吲达帕胺,连续观察12周。治疗前后采用双抗体夹心酶联免疫法检测血清MMP-9和TIMP-1,散射比浊法检测晨尿白蛋白含量,苦味酸法检测尿肌酐含量,计算尿白蛋白与尿肌酐比值。结果治疗12周后,美托洛尔+阿托伐他汀组收缩压、舒张压、心率、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、MMP-9和MAU明显低于治疗前,TIMP-1明显高于治疗前,差异有统计学意义(均P<0.05);治疗后美托洛尔+阿托伐他汀组甘油三酯、总胆固醇、低密度脂蛋白胆固醇、MMP-9和MAU明显低于美托洛尔组,而TIMP-1则明显高于美托洛尔组,差异有统计学意义(均P<0.05)。治疗后美托洛尔组收缩压、舒张压和心率明显下降,与治疗前比较差异有统计学意义(P<0.05)。治疗12周后,美托洛尔+阿托伐他汀组收缩压、舒张压、心率、血糖、高密度脂蛋白胆固醇、谷丙转氨酶、血肌酐、血钾与治疗前比较,差异无统计学意义(均P>0.05)。治疗12周后,美托洛尔组收缩压、舒张压、心率、血糖、高密度脂蛋白胆固醇、谷丙转氨酶、血肌酐、血钾与治疗前比较,差异无统计学意义(均P>0.05)。直线相关分析显示,高血压病早期肾损害患者MMP-1与MAU呈显著正相关(r=0.608,P<0.001),而TIMP-1与MAU呈负相关(r=-0.717,P<0.001)。多因素逐步回归分析显示高血压病早期肾�Aim To investigate the effects of atorvastatin on matrix metalloproteinase-9( MMP-9) and tissue inhibitor of metalloproteinase-1( TIMP-1),and relationship between MMP-9,TIMP-1 and microalbuminuria( MAU) in essential hypertension patients with early renal damage. Methods A total of 120 essential hypertension patients with early renal damage in our hospital were selected from January 2012 to September 2013,and then were randomly divided into the observation group and the control group. The observation group was given atorvastatin 10 mg,qn and metoprolol25 ~ 100 mg / d. The control group was given metoprolol 25 ~ 100 mg / d. After continuous treatment for 12 weeks,the fol Iowing indexes were detected at the beginning and end of the study: MAU,MMP-9 and TIMP-1. The microalbuminuria was calculated by urinary albumin and creatinine ratio. Results There was a significant difference in systolic pressure,diastolic pressure,MAU,MMP-9,TIMP-1,triglyceride( TG),total cholesterol( TC),low density lipoprotein cholesterol( LDLC) and heart rate in the observation group before and after treatment( P < 0. 05). There was a significant difference in MAU,MMP-9,TIMP-1,TG,TC,LDLC between the observation group and the control group( P < 0. 05).There was a significant difference in systolic pressure,diastolic pressure and heart rate in the control group before and after treatment( P < 0. 05). The MMP-9 was positively related and the TIMP-1 was negatively related to the MAU in the essential hypertension. Multiple stepwise regression showed that systolic pressure,MMP-9,and TIMP-1 were three independent factors of the MAU. Conclusion The mechanism of renoprotection of atorvastatin may be related to improvement of the glomerular extracellular matrix degradation.

关 键 词：高血压病 尿微量白蛋白 基质金属蛋白酶9 组织金属蛋白酶抑制物1 阿托伐他汀 

分 类 号：R544.1[医药卫生—心血管疾病]