氨氯地平与培哚普利对老年高血压患者靶器官保护作用的对比研究  

Comparison of protective effects between amlodipine and perindopril on target organs in elderly patients with hypertension

作　　者：吴隐雄[1] 邓金龙[1] 吴东峰[1] 刘杰[1] 廖钦晨[1] 王舟[1] 卢锋[1] 

机构地区：[1]广西壮族自治区人民医院干部综合病房一区,南宁市530021

出　　处：《广西医学》2016年第2期178-182,共5页Guangxi Medical Journal

基　　金：广西医疗卫生重点科研课题(重200959)

摘　　要：目的比较氨氯地平与培哚普利对老年高血压患者靶器官的保护作用。方法 96例老年高血压患者按随机数字表法分为氨氯地平组46例和培哚普利组50例,治疗前及治疗1年后比较两组颈动脉内-中膜厚度(IMT)、肾功能以及心脏结构和功能的变化。结果治疗1年后两组的收缩压、舒张压、24 h动态收缩压、24 h动态舒张压水平均明显下降(P均<0.05);治疗1年后两组颈动脉IMT、尿β2-微球蛋白(β2MG)、尿微量白蛋白(m ALB)、血肌酐均明显降低(P均<0.05),且两组降低程度比较,差异无统计学意义(P>0.05)。治疗1年后两组二尖瓣最大舒张期血流A峰速度(PAV)明显降低、E峰速度(PEV)/PAV明显升高(P<0.05),且氨氯地平组PAV下降幅度高于培哚普利组(P<0.05)。氨氯地平组尿β2MG、尿m ALB、血肌酐及PEV/PAV治疗前后差值与血压(收缩压、舒张压、脉压差或24 h动态收缩压)治疗前后差值呈正相关性(P<0.05),而在培哚普利组中无相关性(P>0.05)。培哚普利组中γ-谷氨酰转肽酶(γ-GT)≥25 U/L亚组尿β2MG、尿m ALB治疗前后差值与收缩压治疗前后差值均呈正相关性(P<0.05),而在γ-GT<25 U/L亚组中无相关性(P>0.05)。结论氨氯地平对心脏舒张功能的保护优于培哚普利;氨氯地平对肾功能和心脏舒张功能的保护作用依赖降压效果,培哚普利对肾功能和心脏舒张功能的保护可能与氧化应激及炎症因子有关。Objective To compare the protective effects between amlodipine and perindopril on the target organs in elderly patients with hypertension. Methods Ninety-six elderly patients with hypertension were divided into amlodipine group（n =46） and perindopril group（n =50） using random number table. Before treatment and after one year of treatment, the carotid intima-media thickness （IMT）, renal function, cardiac structure and function changes were compared between two groups. Results After one year of treatment, the systolic blood pressure, diastolic blood pressure,24-hour dynamic systolic blood pressure and 24-hour dynamic diastolic blood pressure decreased significantly in both groups （ P 〈 0.05 ）. The carotid IMT, urinary β2 -microglobulin （ β2 MG）, urinary microalbumin （mALB）, serum creatinine decreased significantly in both groups after one year of treatment （ P 〈 0.05 ）, and the decrease showed no significant difference between two groups （P 〉 0.05）. After one year of treatment,the mitral diastolic peak A-wave velocity（PAV） decreased significantly and the peak E-wave velocity（PEV）/PAV increased significantly in both groups（P 〈0.05） ,and the decrease of PAV in the amlodipine group was more than that in the perindopril group（P 〈0.05）. In the amlodipine group ,the differences between the levels of urine β2MG, urinary mALB, serum crcatinine and PEV/PAV before treatment and those levels after treatment positively correlated with the difference between the blood pressure （ systolic blood pressure, diastolic blood pressure, difference pressure or 24-hour dynamic systolic blood pressure） before treatment and the blood pressure after treatment （P 〈 0.05 ）. But the correlation above was not observed in the perindopril group（P 〉 0.05）. In the subgroup with γ-glutamyl transpeptidase（γ-GT） ≥25 U/L, the differences between the levels of urinary β2 MG and mALB before treatment and those levels after treatment positively correlated with the differ

关 键 词：高血压 氨氯地平 培哚普利 靶器官 Γ-谷氨酰转肽酶 心功能 肾功能 老年 

分 类 号：R544.1[医药卫生—心血管疾病]