高血压患者凝血、纤溶活性变化及硝苯地平缓释剂对它的影响  

Coagulative and fibrinolytic changes in patients with essential hypertension and the effect of sustained-release nifedipine

作　　者：迟东升 靳风霞[2] 苏玉文[1] 杨曙光[1] 葛斌[1] 吾柏铭[3] 洪小苏[3] 余荣水[3] 

机构地区：[1]解放军88医院心内科,山东泰安271000 [2]泰安市泰山疗养院,山东泰安271000 [3]苏州医学院附属第二医院心内科,江苏苏州215004

出　　处：《第一军医大学学报》2002年第2期168-170,共3页Journal of First Military Medical University

摘　　要：目的观察高血压病(EH)患者血液凝血、纤溶活性变化以及硝苯地平缓释剂对它的影响。方法99例EH患者,按舒张压水平分为轻度48例、中度29例、重度22例,其中随机给25例患者口服硝苯地平缓释剂治疗2周。设健康对照组20例。采用酶联免疫吸附双抗夹心法测定其血浆D-二聚体(DD)、纤维蛋白单体(FM)和组织型纤溶酶原激活剂(tPA)含量。结果EH患者的血浆DD、FM浓度较对照组明显升高,tPA浓度显著下降,且随EH程度加重而显著变化。舒张压与FM呈显著正相关(r=0.374,P<0.001)。EH伴左心室和左心房肥大者的血浆DD、FM和tPA浓度均明显升高。25例经硝苯地平缓释剂治疗患者血浆DD、FM浓度显著下降(P<0.001),而tPA浓度显著升高(P<0.01)。结论EH患者的血液凝血活性明显增强,纤溶活性显著下降,硝苯地平缓释剂可改善EH患者的凝血和纤溶功能失调。Objective To investigatethechangesof coagulationandfibrinolysisstatusinpatientswithessentialhypertension(EH)andobservethetherapeuticeffectof sustained-releasenifedipine.Methods Ninety-nineEH patientsweredivided accordingto theirdiastolicbloodpressure (DBP)intomildgroup(48cases),moderategroup(29cases)andseveregroup(22cases),and25patientsamongthegroupswerechosenat randomto receive sustained-releasenifedipinefor2weeks.Twenty healthysubjectsservedas controlgroup.PlasmaD-dimer(DD),fibrinmonomer(FM)andtissue-typeplasminogenactivitor(tPA)levelsweredeterminedin allthesubjectsby enzyme-linkedimmunosorbentassay(ELISA).Results TheplasmaDD andFMlevelsweremuchhigher,whiletPAlevelwasmuchlowerinhypertensivesthanthoseof normalcontrols,exacerbating withtheseverityof thedisease.DBPwas positivelycorrelatedwithplasmaFM level(r=0.374,P<0.001).In patientswithleft ventricularhypertrophy,leftventriuclarenlargementandleftatrialenlargement,higherlevelsof DD,FM andtPAwere detected.Nifedipinetreatmentproducedsignificantreductionin plasmaDD andFM levels alongwiththeincreasein tPA level [DD:(40.7±23.5)mg/dlvs(23.8±16.5)mg/dl;FM:(7.0±1.6)ng/μl vs(4.8±1.5)ng/μl;tPA:(0.31±0.14)ng/mlvs(0.41±0.05)ng/ml,P<0.001].Conclusion EnahncedcoagulativeactivityandloweredfibrinolyticactivitycharacterizeEHpatients andnifedipinemaycorrect thisdisorder.

关 键 词：高血压 血液凝固 纤维蛋白溶解 纤维蛋白纤维 蛋白降解物 硝苯地平 

分 类 号：R544.1[医药卫生—心血管疾病]