增强型体外反搏对老年原发性高血压伴静息心率增快患者RAAS系统因子等的影响  

Effects of enhanced external counterpulsation on RAAS factors,carotid ultrasound and blood lipids in elderly patients with essential hypertension and increased resting heart rate

作　　者：杨海燕 丁宇 王灿 YANG Hai-yan;DING Yu;WANG Can(Darment of Cardiology,the Eighth People's Hospital of Hebei Province,Shijiazhuang 050024,Hebei,China)

机构地区：[1]河北省第八人民医院心内科,河北石家庄050024

出　　处：《广东医学》2024年第2期200-206,共7页Guangdong Medical Journal

基　　金：河北省医学科学研究课题计划(20220798)。

摘　　要：目的 观察增强型体外反搏对老年原发性高血压伴静息心率增快患者肾素-血管紧张素-醛固酮(RAAS)系统及颈动脉结构和血流动力、同型半胱氨酸(Hcy)、脂蛋白相关磷脂酶A2(Lp-PLA2)及超敏C反应蛋白(hs-CRP)、血脂的影响。方法 将150例老年原发性高血压伴静息心率增快患者随机分为2组,对照组75例予生活干预和富马酸比索洛尔治疗,观察组75例在对照组治疗基础上加增强型体外反搏治疗,疗程均为12周。比较两组治疗前后,RAAS系统指标血浆肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平,颈动脉超声内-中膜厚度(IMT)、血管舒张期内径(Dd)、血管搏动指数(PI)、阻力指数(RI)、舒张末期峰值流速(EDV)、收缩期峰值流速(PSV)、血流最大剪切率(SR),血脂指标及Hcy、Lp-PLA2、hs-CRP水平,血压、心率变化。结果 观察组24 h平均收缩压(24hmSBP)、24 h平均舒张压(24hmDBP)以及日间心率(dHR)、夜间心率(nHR)、24 h心率(24hHR)、AngⅡ、ALD、PRA、hs-CRP、Hcy、Lp-PLA2、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平及颈总动脉IMT、PI、RI、Dd均低于对照组(均P<0.05),颈总动脉EDV、PSV及SR均高于对照组(均P<0.05)。结论 增强型体外反搏治疗老年原发性高血压伴静息心率增快,能抑制患者RAAS系统激活,改善颈动脉粥样硬化和血流动力,抑制炎症反应,调节血脂和Hcy代谢。Objective To observe the effects of enhanced external counterpulsation on renin-angiotensin-aldo-sterone system(RAAS),carotid artery structure and hemodynamics,homocysteine(Hcy),lipoprotein-associated phos-pholipase A2(Lp-PLA2),high sensitivity C-reactive protein(hs-CRP)and blood lipids in elderly patients with es-sential hypertension and increased resting heart rate.Methods A total of 150 elderly patients with primary hypertension and elevated resting heart rate were randomly divided into two groups.The control group(75 cases)received lifestyle in-tervention and treatment with bisoprolol fumarate,while the observation group(75 cases)received enhanced external counterpulsation therapy in addition to the control group's treatment.The duration of treatment was 12 weeks.Before and after treatment,plasma RAAS indicators,including plasma renin(PRA),angiotensin Ⅱ(AngⅡ),and aldosterone(ALD)levels,as well as carotid ultrasound parameters such as intima-media thickness(IMT),diastolic diameter(Dd),pulsatility index(PI),resistance index(RI),end-diastolic velocity(EDV),peak systolic velocity(PSV),and maximum shear rate(SR)were compared.Lipid profiles,Hcy,Lp-PLA2,hs-CRP levels,blood pressure,and heart rate changes were also assessed.Results In the observation group,24-hour average systolic blood pressure(24hmSBP),24-hour average diastolic blood pressure(24hmDBP),daytime heart rate(dHR),nighttime heart rate(nHR),24-hour heart rate(24hHR),Ang Ⅱ,ALD,PRA,hs-CRP,Hcy,Lp-PLA2,total cholesterol(TC),tri-glycerides(TG),and low-density lipoprotein cholesterol(LDL-C)levels,as well as carotid IMT,PI,RI,and Dd were all lower than those in the control group(all P<0.05).Carotid EDV,PSV,and SR were higher in the observation group than those in the control group(all P<0.05).Conclusion Enhanced external counterpulsation therapy for elderly patients with primary hypertension and elevated resting heart rate effectively inhibits the activation of the RAAS system,improves carotid atherosclerosis and hemodynamics,suppresses inflammatory respon

关 键 词：老年高血压 静息心率 增强型体外反搏 肾素-血管紧张素-醛固酮 血脂 同型半胱氨酸 颈动脉超声 

分 类 号：R544.11[医药卫生—心血管疾病] R541.71[医药卫生—内科学]