西拉普利对高血压病伴脑腔隙性梗塞患者危险因素逆转研究  

Cilazaepril,Reverse Some Risk Factor for Lacuna Infarction Patients with EssentialHypertension

作　　者：郭冀珍[1] 龚艳春[1] 王德治[1] 唐晓峰[1] 洪洁[1] 宁光[1] 龚兰生[1] 

机构地区：[1]上海第二医科大学附属瑞金医院

出　　处：《中国临床药理学杂志》2002年第2期94-97,共4页The Chinese Journal of Clinical Pharmacology

基　　金：上海市科委基金(98-4419063)

摘　　要：目的:血管紧张素转换酶抑制剂(ACEI)西拉普利对非糖尿病高血压合并脑腔隙性梗塞(腔梗)某些危险因素逆转.方法:对53例非糖尿病高血压合并腔梗病人(男:32人,女:21人;平均年龄:55±7岁)分成两组:ACEI西拉普利组,剂量:每天2.5～5mg(平均每天3.0g)(n=38)和β受体阻滞剂,美多心安组,剂量:每天25～100mg,(平均每天42.6mg)(n=17).随访8个月到18个月(平均16个月).在服药前后检查了脑病灶磁共振(MRI)定量,从糖耐量试验和胰岛素释放试验结果计算出Cederholm胰岛素敏感性指数(ISIc),血脂(Tc、Tb、LDL-c、HDL-c等),血尿酸,PAI-1,tPA及尿微量白蛋白等.结果:(1)按糖耐量试验结果,53例病人分成两组:糖耐量异常(IGT)组(n=15)和糖耐量正常(NGT)组(n=38),两组ISIc分别为:39.1±7.9,61.2±21.lmin-1·mU·L-1(P<0.05)和腔梗定量154.6±116.4,88.5±80.8m2(P<0.05).(2)服药后16月(平均)比较西拉普利组(n=36)和美多心安组(n=17):ISIc在西拉普利组明显改善,美多心安明显减退.糖尿病发生率两组分别为8.3%(3/36)和9.4%(5/17).血压两组均有下降,下降幅度无明显差别.Tg,Tc和LDL-c,血尿酸和PAl-1在美多心安组明显上升,而在西拉普利组血尿酸,PAI-1,LDL-c均明显下降.但两组组间比下降幅度均未达显著性差别.结论:ACEI,西拉普利可以逆转高血压病腔梗病人的某些危险因素,如血脂代谢,尿酸,PAI-l,ISIc及减少糖尿病发生率.提示血管紧张素转换酶抑制剂,西拉普利对高血压病人脑部小血管有保护作用.OBJECTIVE: To evaluate the changes of some risk factors for lacunainfarction(LI)in non-diabetic essential hypertension(EH) patients before and afterthe administration of ACEI, cilazaepril., METHOD:fifty-three patients with LI andEH.(M:32,F:2l;Age:55±7),divided into two groups:treatment with ACEI, cilazaepril(c), 25-5mg.d-1, (Average:3.0mg.d-1)(n=36) andβ-blocker, metopronolol(M),25~100mg.d-1(Average:42.6mg.d-1)(n=17),follewed for eight to eighteen months(Average:sixteen months). Quantification of LI in MRI with computer; Cedeholminsulin sensitivity index (ISIc) calculated from the results of oral glucose tolerancetest(OGTT) and insulin release test(inRT); lipid (Tc,Tg,LDL-c,HDL-c); serum uricacid(UA);PAI-l;tPA and urinary microalbumin were studied before and aftermedication.RESULTS:(l)According to the results from OGTT, fifty-three patientswere divided in to two groups: IGT(n=l5) and NGT (n=38)groups.In which ISIc andquantification of LI were 39.l±7.9, 6l.2±2l.l min-1.mu.L-1(P<005) and l54.6±ll6.4mm2, 88.5±80.8mm2(P<0.05),respectively(2)Comparing the treatment groups of C(n=36) with M(n=l7) some risk factors:ISIc in C groups significantly improved than in M groups(P<0.05); the incidents ofdiabetic were 8.3%(3/36) and 29.4%(5/l7)respectively; Tg,LDL-c,UA and PAI-l significantly decreased in C groups but Tg, Tc, LDL-c UA significantly decreased in Mgroup.CONCLUSION: ACEI, cilazaepril seems to improve some risk factors of LI with EH, including lipid metabolism, uric acid,PAI-l,ISIc,besides lower blood pressure.In the meantime, lower incidence of diabetic was found in cilazaepril than inmetopromolol group.It suggest that ACEI,cilazaepril could protect micro-cerebral vessel in EH patients.

关 键 词：血管紧张素转换酶抑制剂 脑腔隙性梗塞 危险因素 西拉普利 高血压 

分 类 号：R544.1[医药卫生—心血管疾病] R743.33[医药卫生—内科学]