氟伐他汀和缬沙坦联合治疗改善原发性高血压患者高脂餐后纤溶功能  

Effect of Fluvastatin and Valsartan Combination Treatment on Postprandial Fibrinolytic Dysfunction in Patients with Essential Hypertension

作　　者：刘玲[1] 赵水平[1] 周宏年[1] 文铁[2] 许丹焰[1] 李冀香[3] 

机构地区：[1]中南大学湘雅二医院心血管科,湖南长沙410011 [2]中南大学湘雅二医院急诊科,湖南长沙410011 [3]中南大学湘雅二医院营养科,湖南长沙410011

出　　处：《中华高血压杂志》2008年第2期128-132,共5页Chinese Journal of Hypertension

基　　金：国家自然科学基金资助项目(30500209);教育部"新世纪优秀人才支持计划"资助课题(NCET-06-0684)

摘　　要：目的观察氟伐他汀和缬沙坦联合治疗对原发性高血压患者高脂餐后血浆纤溶酶原激活物抑制剂1 (PAI-1)和组织型纤溶酶原激活剂(t-PA)抗原浓度的即期影响。方法原发性高血压患者53例随机分成对照组(安慰剂,n=13)、氟伐他汀组(40 mg/d,n=13)、缬沙坦组(80 mg/d,n=14)和联合组(氟伐他汀:40 mg/d+缬沙坦:80 mg/d,n=13)4组治疗1周,禁食12 h后测高脂餐前(空腹,F)、后(4 h,P)的血浆可溶性P选择素、PAI-1和t-PA抗原及血脂浓度。4组分别治疗1周后再重复以上实验1次,并测量4组治疗前、后的血压。结果高脂餐后血浆三酰甘油(TG)[F:(1.94±0.91)比P:(3.15±1.48)mmol/L]、可溶性P选择素[F:(259.8±124.0)比P: (345.7±138.4)ng/mL]、PAI-1[F:(36.4±13.1)比P:(48.7±18.5)ng/mL,]和t-PA抗原[F:(9.6±3.2)比P: (13.5±6.0)ng/mL]浓度升高,差异有非常显著意义。高脂餐后血浆TG浓度分别与高脂餐后可溶性P选择素(r=0.430)、PAI-1抗原(r=0.421)浓度显著相关(P<0.01)。治疗1周后,缬沙坦组和氟伐他汀组的高脂餐后血浆可溶性P选择素、PAI-1和t-PA抗原浓度较各自空腹水平差异无统计学意义。联合组的空腹和高脂餐后血浆可溶性P选择素、PAI-1和t-PA抗原浓度较治疗前基础水平显著降低(P<0.05)。联合治疗一周后也明显地抑制了高脂餐后可溶性P选择素、PAI-1与t-PA,虽然仍有轻度增加,但差异无统计学意义(P>0.05)。上述指标的变化发生在血脂变化之前。结论与氟伐他汀或缬沙坦的单用相比,极短期两药联合应用有效地降低了原发性高血压患者空腹和高脂餐后的血浆PAI-1和t-PA抗原浓度。Objective To explore the effect of combined fluvastatin and valsartan treatment for 1 week on postprandial fibrinolytic dysfunction after a high-fat meal in patients with essential hypertension （EH）. Methods Fifty three EH patients were enrolled. The concentrations of plasma lipid profiles, soluble P-selectin, tissue plasminogen activator （ t-PA） and plasminogen activator inhibitor type Ⅰ（PAI-1） antigens were measured in fasting state（ F） and 4 hours after a single high-fat meal （P）. Patients randomly received placebo, fluvastatin 40 mg/d, valsartan 80 mg/d, or fluvastatin 40 mg/d ＋ valsartan 80 mg/d for one week. Results Before treatment the postprandial plasma triglyceride （F： 1.94 ±0. 91 vs P： 3. 15± 1.48 mmol/L）, soluble P-selectin （F： 259.8±124. 0 vs P： 345.7±138. 4 ng/mL）, PAI-1（F： 36. 4±13.1 vs P： 48. 7±18. 5 ng/mL） and t-PA antigen IF： 9.6±3. 2 vs P： 13.5±6. 0 ng/mL） concentrations were all significantly increased after a high-fat meal. Postprandial plasma concentration of triglyceride was significantly correlated with that of soluble P-selectin （r= 0. 430） and PAI-1 antigen （r =0. 421）, respectively（P〈0. 01）. Fluvastatin or valsartan monotherapy for 1 week slightly and nonsignificantly attenuated the postprandial P-selectin, PAI-1 and t-PA antigen level （ all P〉0.05）, while combination treatment of fluvastatin significantly decreased both fasting and postprandial P-selectin, plasma PAI-1 and t-PA antigen levels （all P〈0. 05）. The improvement of these plasma fibrolytic variables occurred prior to the changes of plasma lipids profiles. Conclusion Short-term combined treatment with fluvastatin and valsartan more effectively decreased the fasting and postprandial PAI-1 and t-PA antigen levels in plasma than monotherapy.

关 键 词：高脂餐 原发性高血压 纤溶功能 他汀 血管紧张素Ⅱ受体拮抗剂 

分 类 号：R544.1[医药卫生—心血管疾病] R972.6[医药卫生—内科学]