替米沙坦对伴有冠心病的原发性高血压患者左室重构、C反应蛋白及心功能的影响  

Effects of telmisartan on the levels of hs-CRP,left ventricular remodeling and left ventricular function in patients with essential hypertension and coronary heart disease

作　　者：李庆辉[1,2] 杨天伦[2] 谭碧峰[3] 周环[2] 周波[2] 

机构地区：[1]湖南农业大学医院心内科,湖南长沙410128 [2]中南大学湘雅医院心内科,湖南长沙410008 [3]怀化医学院附属怀化市第三人民医院心内科,湖南怀化418000

出　　处：《心脏杂志》2010年第5期747-750,757,共5页Chinese Heart Journal

摘　　要：目的：探讨替米沙坦对伴有冠心病的原发性高血压（EH）患者左室重构、超敏-C反应蛋白（hs-CRP）及心功能的影响。方法：选择并发有冠心病的原发性高血压患者120例，随机分为替米沙坦组（49例）和贝那普利组（44例），分别予以替米沙坦口服（80～160mg／d）和贝那普利口服（10～20mg／d），每日1次，疗程均为24周，治疗前后分圳测阻胝、血脂、尿酸（UA）、hs—CRP和超声心动图测定左室结构和功能，对比分析治疗前、后各指标的差异。结果：①与治疗前比较，替米沙坦组和贝那普利组治疗后收缩压和舒张压明显下降（161／101至130／83mmHg；160／102至131／85mmHg，均为P〈0．01）；②替米沙坦治疗后，三酰甘油（TG）、舒张期室间隔厚度（IVST）、舒张期左室后壁厚度（LVPWT）、左室舒张末内径（LVEDD）、A／E明显降低（P〈0．05）；UA、左室射血分数（LVEF）、hs-CRP及左室质量指数（LVMI）下降非常显著（P〈0．01）；贝那普利组治疗后无明显的变化，但hs-CRP、LVMI明显下降（P〈0．05）；两组治疗后比较，替米沙坦组UA、LVMI明显下降及LVEF明显改善（P〈0．05）；③直线相关分析显示：hs-CRP与LVMI呈正相关（r=0．61，P〈0．05）。结论：替米沙坦和贝那普利均能有效降低EH患者的血压水平与贝那普利比较，替米沙坦还能显著降低hs-CRP水平以及改善三酰甘油代谢和血UA代谢，并使EH患者LVH显著逆转和心功能明显改善。AIM： To investigate the effects of tehnisartan on the levels of high sensitivity CRP （hs-CRP）, left ventrieular remodeling and left ventricular functions in patients with essential hypertension and coronary heart disease. METHODS： One hundred and twenty patients with coronary heart disease and essential hypertension with lefi ventricular hypertrophy （LVH） were randonfized into the telmisartan group （49 cases） or benazepri group（44 cases） and were treated with telmisartan （80- 160 mg/d） or benazepril （10- 20 rag/d）. Tile patients were followed-up for 24 weeks and the levels of cholesterol, fasting plasma glucose （FPG）, uric acid （UA） and hs-CRP were measured before and arier treatment. Color Doppler echocar- diography was used to study the left ventricular structure and functions. RESULTS： After 24 weeks of treatment with telmisartan or benazepril, blood pressure reduced from 161/101 to 130/83 mmHg （P 〈 0.01 ） or from 160/102 to 131/85 mmHg （P 〈0. 01 ） respectively. At the end of 24 weeks, significant decrease was observed in TG, IVST, LVPWT, LVDd and A/E （P 〈 0. 05）, as well as in UA, LVEF, hs-CRP and LVMI （P 〈0. 01 ） in patients treated with telmisartan. In patients treated with benazepril, significant decrease was seen only in hs-CRP and LVMI （ P 〈 0. 05 ）. No significant changes were observed in total cholesterol, HDL-C and LDL-C in either group. Linear regression analysis indicated that hs-CRP was strongly associated with LVMI （P 〈 O. 05）. CONCLUSION： Telmisartan and benazepri are all effective in reducing blood pressure, But telmisartan is better than benazepri in regulating the levels of TG, UA, hs-CRP, and improving left ventricular functions and reversing LVH.

关 键 词：替米沙坦 高血压痛 原发性 左心室肥厚 冠状动脉疾病 C反应蛋白 

分 类 号：R544.1[医药卫生—心血管疾病]