高血压病患者微血管改变与血管内皮细胞损伤关系及开搏通的影响  

Microvascular Alterations and Endothelial Injury in Patients with Essential Hypertension and Effects of Captopril on Them

作　　者：吴强[1] 雷鸣[2] 曾祖荫[2] 郭渝成[2] 张志高[2] 李金生 

机构地区：[1]省人民医院心内科,贵州省贵阳市550002 [2]解放军第44医院 [3]贵阳医学院

出　　处：《中国微循环》2000年第3期145-147,共3页Journal of Chinese Microcirculation

摘　　要：探讨不同期高血压病(EH)患者微血管改变与血管内皮细胞(VEC)损伤、功能障碍的关系及开搏通(CPT)对其的影响。方法对Ⅰ期、Ⅱ期及Ⅲ期EH患者各20例应用CPT口服治疗10日 ,观察治疗前后球结膜微血管、血浆一氧化氮(NO)、内皮素(ET)浓度及循环内皮细胞(CEC)计数的变化 ,并与正常对照组(NC组 ,n=23)比较。结果治疗前 ,66.67 %的EH患者出现球结膜缺血区 ,明显多于NC组(P<0.001)。EH患者的微动脉与微静脉管径比(A/V)、NO低于NC组(P均<0.001) ,而ET和CEC则高于后者(P<0.05) ,且这种变化随病情严重而加重。EH患者的A/V与NO呈正相关(r=0.6533,P<0.01)、并分别与ET和CEC呈负相关(r= -0.5607,P<0.01;r= -0.7182,P<0.01)。经CPT治疗后 ,EH患者的血压降低(P<0.001),A/V和NO增大(P<0.001和P<0.01) ,ET和CEC下降(P<0.05和P<0.01) ,Ⅰ、Ⅱ期患者的缺血区减少(P<0.05～0.01)。结论EH的微血管改变与VEC损伤关系密切。CPT可以减少EH患者的缺血区、扩张其微动脉 。Objective To study the relationship between microvascular alterations and endothelial injury in patients with essential hypertension(EH) and to investigate the effect of captopril(CPT) on them . Methods 60 cases with EH (EH group) including 20 at stage Ⅰ、20 at Ⅱand 20 at Ⅲwere treated with CPT for 10 days. The blood pressure and changes of microvasculature of the bulbar conjunctiva were recorded before and after treatment. Plasma nitric oxide (NO)、 endothelin (ET) determination, as well as counts of circular endothelial cells(CEC) were obtained. 23 healthy persons served as normal control group(NC group). Results Ischemic areas were found in 40 patients (66.7%)in EH group, and only one in NC group (P<0.001).The arteriole diameter/venule diameter(A/V) ratio in the bulbar conjunctiva of the hypertensives before therapy was remarkably smaller than that of the normotensives (0.001), ET level and count of CEC were significantly higher(P<0.05) and NO level was remarkably lower(P<0.001) in EH group before treatment than those in NC group. These changes were correlated to the severity of disease. The plasma NO, plasma ET and count of CEC of the hypertensives were relative with their A/V ratio (P<0.01). In EH group after treatment, the A/V ratio and the plasma level of NO increased (0.05～0.01, vs.pretreatment), while ET and CEC reduced (P<0.05～0.001, vs.pretreatment). The number of ischemic areas decreased in patients with EH at stage Ⅰand Ⅱ(P<0.05～0.01, vs.pretreatment). Conclusions The microvascular alterations were correlated to endothelial function in patients with EH. CPT can reduce ischemic areas and dilate arteriole by protecting structure and function of VEC in hypertensives.

关 键 词：高血压 开搏通 微血管 内皮细胞 病理 

分 类 号：R544.102[医药卫生—心血管疾病]