ACEI/ARB类和CCB类降压药对高血压性脑出血患者血清炎性因子水平和预后的影响  

Effect of ACEI/ARB and CCB on serum inflammatory cytokines and prognosis of patients with hypertensive intracerebral hemorrhage

作　　者：武丽芳[1] 杜剑峰[1] 

机构地区：[1]延安大学附属医院神经内科,陕西延安716000

出　　处：《实用药物与临床》2016年第9期1104-1107,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨ACEI/ARB类和CCB类降压药对高血压性脑出血患者急性期血清炎性因子水平和预后情况的影响。方法 127例高血压性脑出血患者按照脑出血前服用降压药的种类分为A组(35例,脑出血发病前已规范服用ACEI/ARB类降压药)、B组(28例,脑出血发病前已规范服用CCB类降压药)和C组(64例,脑出血发病前未规范服用任何降压药),进一步将C组患者随机分为2组,记为D组(脑出血发病后规范服用ARB类降压药)和E组(脑出血发病后规范服用CCB类降压药),各32例。于发病第3天检测所有患者血清IL-1β、IL-6、TNF-α的水平,同时复查头颅CT评估脑水肿情况。发病第1天和第30天时,按照NIHSS评分标准评估患者神经缺损状况。结果发病第3天时,A组和B组患者血清IL-1β、IL-6、TNF-α水平及血压脑水肿体积均显著低于C组(P<0.05),但A、B组组间及D、E组组间各指标比较差异无统计学意义(P>0.05);发病30 d各组死亡率比较差异无统计学意义(P=0.70),但A组和B组NIHSS评分均显著低于C组(P=0.01,P=0.04),A、B组组间及D、E组组间NIHSS评分比较差异无统计学意义(P=0.74,P=0.64)。结论对于高血压性脑出血患者,早期规范服用ACEI/ARB类或CCB类降压药可改善患者预后情况,可能与降低血清多种炎性因子水平相关。Objective To study the effect of ACEI/ARB and CCB on serum inflammatory cytokines and prognosis of patients with hypertensive intracerebral hemorrhage （HICH）. Methods Totally 127 cases with HICH were divided into group A （ taking ACEI/ARB regularly before the onset of ICH, n = 35 ） , group B （ taking CCB regularly before the onset of ICH, n = 28 ） and group C （ taking no antihypertensive before the onset of ICH, n = 64 ）. Then patients of group C were randomly divided into group D （ taking ARB regularly after the onset of ICH, n = 32 ） and group E （ talking CCB regularly after the onset of ICH, n = 32 ） by random number table. On the third day after the onset of ICH, the serum levels of IL-1β, IL-6 and TNF-α were detected, meanwhile, head CT was reviewed to evaluate intracranial edema. On the 1 st and 30th day ,the degree of nervous function defect of patients was evaluated by NIHSS. Results On the third day, the serum inflammatory cytokines, blood pressure and the cerebral edema volume of group A and group B were lower than those of group C （ P 〈 0. 05 ）. However, there was no significant difference between group A and group B, or between group D and group E（ P 〉 0. 05 ）. On 30th day, no significant difference in mortality among the groups was found（ P = 0. 70） ,but the NIHSS of group A and group B was still lower than group C（ P = 0. 01, P = 0. 04 ） , there was no significant difference between group A and group B （P = 0.74 ） , or between group D and group E （ P = 0. 64 ）. Conclusion Before the onset of ICH, taking ACEI/ARB and CCB regularly can improve the prognosis for patients with HICH, which may be related to down-regulating the serum inflammatory cytokines.

关 键 词：降血压药 高血压 脑出血 炎性因子 

分 类 号：R544.1[医药卫生—心血管疾病] R743.34[医药卫生—内科学]