钙通道阻断剂联合血管紧张素Ⅱ的1型受体阻断剂改善合并左心室肥厚的绝经后高血压女性患者左心室舒张功能异常的临床研究  

Clinical study on the effect of calcium channel blocker combined with angiotensinⅡtype 1 receptor blocker on left ventricular diastolic dysfunction in postmenopausal hypertension women patients with left ventricular hypertrophy

作　　者：马瑞新[1] 李宁荫[1] 王琼英[1] 丁虹 余静[1] Ma Ruixin;Li Ningyin;Wang Qiongying;Ding Hong;Yu Jing(The Third Department of Cardiology,Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院心血管内科三病区,兰州730030

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2022年第3期208-216,共9页Chinese Journal of Heart Failure and Cardiomyopathy

基　　金：国家自然科学基金项目(81270332,81670385);甘肃省自然科学基金项目(1506RJZA244);甘肃省卫生行业科研计划项目(GSWSKY2017-02);兰州大学第二医院萃英科技创新计划项目(CY2018-QN05)。

摘　　要：目的:评估钙通道阻滞剂(CCB)——氨氯地平联合较大剂量血管紧张素Ⅱ的1型受体阻断剂(ARB)——缬沙坦在降压达标基础上对已经绝经的合并左心室肥厚(LVH)的高血压女性患者左心室舒张功能异常(LVDD)的改善作用。方法:本研究为前瞻性、开放的平行对照研究,入选2016年12月至2017年4月期间于兰州大学第二医院就诊的103名45~65岁高血压合并LVH的自然绝经后女性,分为A组和B组,前者给予氨氯地平(5 mg/d)+较大剂量缬沙坦(160~320 mg/d),后者给予氨氯地平(5 mg/d)+缬沙坦(80 mg/d)。随访18个月,于治疗前后分别检测血清各项生化指标、肾素血管紧张素系统(RAS)组分、Ⅰ型和Ⅲ型胶原、8羟基脱氧鸟苷、超氧化物歧化酶、谷胱甘肽及α-平滑肌肌动蛋白;评估24小时动态血压平均值、负荷值及变异系数,以及动态动脉硬化指数(AASI),超声心动图评估心脏功能。结果:(1)两组患者入组时基线临床特征具有可比性。(2)两组患者24小时动态血压均降压达标,差异无统计学意义,但治疗后A组患者AASI低于治疗前及B组治疗后的水平(P均<0.05)。(3)两组患者氧化应激及心肌纤维化指标在治疗前后差异均无统计学意义(P均>0.05)。(4)治疗18个月后A组患者的血管紧张素(1-7)、血管紧张素(1-9)及血管紧张素转化酶2(ACE2)升高,而ACE的水平降低(P均<0.05),但B组患者仅有血管紧张素(1-7)的水平升高(P<0.05)。(5)A组患者治疗18个月后舒张末期室间隔厚度及左心室质量降低(P均<0.05),二尖瓣E/e′比值降低,e′/a′比值升高(P均<0.05),左心室舒张功能改善,但B组未有同样的改变。(6)两组患者不良反应的发生情况类似(P均>0.05)。结论:CCB联合相对充分剂量ARB,可以在一定程度上改善已经绝经的合并LVH的高血压女性患者的左心室舒张功能。Objective To evaluate the effect of calcium channel blocker(CCB)amlodipine combined with larger dose of angiotensinⅡtype 1 receptor blocker(ARB)valsartan on improving left ventricular diastolic dysfunction(LVDD)in postmenopausal hypertensive women patients with left ventricular hypertrophy(LVH).Methods This prospective,open parallel controlled study enrolled 103 natural postmenopausal women patients aged 45-65 years with hypertension and LVH who presented in Lanzhou University Second Hospital from December 2016 to April 2017.Patients were divided into group A and group B.The former group was given amlodipine(5 mg/d)plus higher dose of valsartan(160~320 mg/d),and the latter group was given amlodipine(5 mg/d)plus valsartan(80 mg/d).All patients were followed up for 18 months.The serum biochemical indexes,renin angiotensin system(RAS)components,typeⅠand typeⅢcollagen,8-hydroxy-deoxyguanosine(8-OHdG),superoxide dismutase(SOD),glutathione(GSH)andα-smooth muscle actin(α-SMA)were detected before and after treatment of 18 months.Moreover,mean 24-hour ambulatory blood pressure,load value and coefficient of variation,and ambulatory arterial stiffness index(AASI)were evaluated.Cardiac structure,systolic and diastolic function were assessed by echocardiography.Results(1)There were no significant differences in clinical characteristics between the two groups when enrolled(all P>0.05).(2)Patients on both group have reached the target blood pressure on 24-hour ambulatory blood pressure monitoring without significant difference.However,the AASI level of group A after treatment was lower than that before treatment and group B after treatment(all P<0.05).(3)There were no significant differences in oxidative stress and myocardial fibrosis parameters between the two groups before and after treatment(all P>0.05).(4)After 18 months of treatment,angiotensin(1-7),angiotensin(1-9)and angiotensin converting enzyme 2(ACE2)were increased while ACE levels were decreased significantly(all P<0.05)in the group A,whereas only angiotensin

关 键 词：高血压 左心室肥厚 左心室舒张功能 绝经后 联合治疗 

分 类 号：R544.1[医药卫生—心血管疾病]