高血压病左心室肥厚与血管活性物质的关系及依那普利干预  

Effects of Vasoactive Substances on Left Ventricular Hypertrophy and Its Regression by Enalapril in Essential Hypertensives

作　　者：商黔惠[1,2] 王丕荣[1,2] 李琮辉[1,2] 冼惠珍 马淑玉[1,2] 张桂兰 文雍[1,2] 邱玉明 

机构地区：[1]遵义医学院附属第一医院心内科 [2]遵义407厂职工医院内科

出　　处：《中国循环杂志》1997年第4期257-260,共4页Chinese Circulation Journal

摘　　要：目的：探讨体循环血液中多种血管活性物质在高血压病左心室肥厚（ＬＶＨ）发生和依那普利（ｅｎａｌａｐｒｉｌ）逆转治疗中的作用。方法：测定高血压病患者４５例合并ＬＶＨ、４５例不合并ＬＶＨ及３０例正常人血流动力学和血浆５种血管活性物质，观察２７例高血压病患者合并ＬＶＨ依那普利治疗２４周后各项参数变化。结果：合并ＬＶＨ组收缩压、血浆内皮素、去甲肾上腺素、内源性洋地黄物质（ＥＤＬＳ）和心钠素高于不合并ＬＶＨ组（Ｐ＜０．０５～０．０１），血管紧张素Ⅱ高于正常人（Ｐ＜０．０１）；对１３个相关因素进行逐步回归分析表明，内皮素、血管紧张素Ⅱ和去甲肾上腺素对ＬＶＨ作用显著（复相关系数０．７６９，Ｐ＜０．００１）；内皮素、血管紧张素Ⅱ、去甲肾上腺素、ＥＤＬＳ之间呈正相关（Ｐ＜０．０５～０．０１）；依那普利干预后，ＬＶＨ消退，血压和血管活性物质同步下降（Ｐ＜０．０５～０．０１）。结论：体循环血液中多种血管活性物质含量改变及其相互作用可能共同参与高血压病ＬＶＨ的形成，依那普利消退ＬＶＨ的机制可能与降低这些物质有关。Objective:To study the relationship between vasoactive substances and left ventricular hypertrophy(LVH)and the regression of LVH by enalapril in patients with essential hypertension (EH). Methods:Hemodynamics and plasma endothelin(ET),angiotensin Ⅱ(Ang Ⅱ),endogenous digitalis like substances(EDLS),norepinephrine(NE)and atrial natriuretic peptide(ANP) were determined in forty five EH patients with LVH,45 EH patients without LVH and 30 normal subjects. In 27 EH patients with LVH treated with enalapril for 24 weeks, the mentioned parameters were repeated. Results:It was found that systolic blood pressure,plasma ET,NE,EDLS and ANP were higher in EH patients with LVH than those in patients without LVH.Ang Ⅱ in patients with LVH was higher than in normal subjects.Multiple stepewise regression analysis revealed that plasma ET,Ang Ⅱ and NE were three important factors affecting LVH in patients with LVH.ET,Ang Ⅱ,NE and EDLS had a positive correlation with each other in patients with LVH.After treated with enalapril,LVH was regressed accompanied by the decrease of such plasma vasoactive substanes. Conclusion:The above results suggest that the change of plasma vasoactive substances levels and the interaction among them may play some role in the pathogenesis of LVH in EH patients,and the LVH regression effect of enalapril might be mediated by depressing such vasoactive substances.

关 键 词：高血压 左心室肥厚 血管活性物质 依那普利 

分 类 号：R544.1[医药卫生—心血管疾病]