不同血管紧张素受体拮抗剂对老年高血压患者血小板活性的影响  

Impact of different angiotensin receptor blockers on platelet activity in elderly hypertensive patients

作　　者：李嫣然[1] 王红艳[1] 吴方[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院老年病科,200025

出　　处：《国际心血管病杂志》2014年第6期412-415,共4页International Journal of Cardiovascular Disease

基　　金：上海市科委基金(124119a6800)

摘　　要：目的:探讨氯沙坦、厄贝沙坦及缬沙坦3种血管紧张素受体拮抗剂(ARB)对老年高血压患者血小板活性的影响。方法:入选年龄>65岁、长期服用ARB的老年高血压患者90例,根据用药情况分成氯沙坦、厄贝沙坦、缬沙坦3个治疗组。分别测定各组血小板聚集率(PAR)、血管紧张素Ⅱ(AngⅡ)、环氧化酶-2(COX-2)、血栓素B2(TXB2)水平。比较经不同ARB处理的内皮细胞中,由AngⅡ诱导产生的COX-2 mRNA及蛋白表达量、TXB2水平。结果:氯沙坦、厄贝沙坦及缬沙坦组3组的PAR分别为12.62%±0.74%、10.70%±0.70%和17.17%±1.44%,P<0.001;COX-2分别为(81.04±14.19)、(75.00±11.14)、(145.10±26.52)U/L,P=0.012;TXB2为(1 577.00±161.90)、(1324.00±121.40)、(2 025.00±154.10)pg/ml,P=0.004。与氯沙坦组相比,厄贝沙坦、缬沙坦组COX-2 mRNA及蛋白表达、TXB2水平下降更为显著,P<0.01。结论:厄贝沙坦、缬沙坦通过抑制COX-2/TXB2表达,能更有效地抑制老年高血压患者的血小板活性。Objective： To investigate the different inhibitory effects of lorsartan, irbesartan and valsartan on platelet aggregation in elderly hypertensive patients. Methods： According to varied medication history,90 enrolled hypertensive patients over the age of 65 were divided into lorsartan （n = 30）, irbesartan （n = 30） and valsartan （n = 30） treatment group. Then,platelet aggregation rate （PAR） and plasma levels of angiotension Ⅱ （Ang Ⅱ ）, COX-2 and TXB2 were determined. Human aortic endothelial cells （HAECs） were stimulated by Ang Ⅱ with or without treatment of lorsartan, irbesartan and valsartan, and the relative expression of COX-2 and TXB2 was assessed. Results：PAR was lower with the treatment of irbesartan and valsartan compared with lorsartan （12. 62% ± 0. 74%,10. 70%± 0.70% and 17.17% ± 1. 44%）, P〈0. 001 among three groups],associated with more reduced plasma levels of COX-2[（81.04 ± 14. 19）U/L,（75. 00 ± 11. 14）U/L and（145. 10 ± 26. 52）U/L, P = 0. 012 among three groups]and TXB2 [（1577.00 ± 161.90）pg/ml,（1 324.00 ±121.40）pg/ml and（2 025.00 ±154. 10）pg/ml, P = 0. 004 among three groups]. Relative increased expression in HAECs of COX-2 and secretion of TXB2 stimulated by Ang Ⅱ were more significantly inhibited by irbesartan or valsartan, respectively compared with lorsartan, P〈 0. 01. Conclusion： Irbesartan and valsartan may more effectively decrease platelet activity in elderly hypertensive patients by attenuating the expression of COX-2/TXB2

关 键 词：老年高血压 血小板活性 环氧化酶-2 氯沙坦 厄贝沙坦 缬沙坦 

分 类 号：R544.1[医药卫生—心血管疾病]