高血压伴冠心病患者无创心输出量测量下个体化方案治疗的效果及机制  

Therapeutic effect and mechanism of individualized treatment for hypertension patients with coronary heart disease under non-invasive cardiac output measurement

作　　者：黄海芬[1] 陈清勇 何芳[1] 李韧[1] HUANG Haifen;CHEN Qingyong;HE Fang;LI Ren(the First People's Hospital of Chenzhou City in Hunan Province,Chenzhou,Hunan,423000)

机构地区：[1]湖南省郴州市第一人民医院,湖南郴州423000

出　　处：《实用临床医药杂志》2025年第5期70-75,81,共7页Journal of Clinical Medicine in Practice

基　　金：湖南省卫生健康委科研计划项目(202202052843);湖南省郴州市技术创新引导项目(lcyl2021021)。

摘　　要：目的探讨无创心输出量测量下个体化方案治疗高血压伴冠心病患者的效果及机制。方法将2020年1月—2022年8月本院94例高血压伴冠心病患者随机分为2组,每组47例。对照组采取常规治疗方案,观察组采取无创心输出量测量下个体化治疗方案,均持续治疗3个月。比较2组临床疗效、血压控制情况[舒张压(DBP)、收缩压(SBP)]、心脏超声参数[左室收缩末期内径(LVESD)、左室质量指数(LVMI)、室间隔厚度(IVS)、左室舒张末期内径(LVEDD)]、心率变异性[RR间期平均值标准差(SDANN)、窦性心搏RR间期的标准差(SDNN)、窦性心搏个数中相邻NN>50 ms的个数占比(PNN50)]、心肌损伤指标[α羟丁酸脱氢酶(α-HBDH)、乳酸脱氢酶(LDH)、肌酸激酶(CK)]、转化生长因子-β1(TGF-β1)/胰腺癌缺失因子(Smads)信号通路及主要不良心血管事件(MACE)发生率。结果观察组总有效率为95.74%,对照组为85.11%,差异无统计学意义(P>0.05)。治疗1、3个月后,2组DBP、SBP水平均较治疗前降低,差异有统计学意义(P<0.05);观察组LVMI、LVESD、IVS、LVEDD均低于对照组,差异有统计学意义(P<0.05)。治疗3个月后,观察组SDANN、PNN50、SDNN均高于对照组,CK、α-HBDH、LDH以及TGF-β1/Smads信号通路因子TGF-β1RⅠ、TGF-β1RⅡ、Smad1、Smad2表达水平低于对照组,差异有统计学意义(P<0.05)。随访3个月,观察组MACE发生率为6.38%,与对照组14.89%比较,差异无统计学意义(P>0.05)。结论与常规治疗方案相比,无创心输出量测量下个体化治疗方案能显著减轻心肌损伤程度,逆转心室肥厚,改善心率变异性,其机制可能与抑制TGF-β1/Smads信号通路有关。Objective To investigate the efficacy and mechanism of individualized treatment for hypertension patients with coronary heart disease under non-invasive cardiac output measurement.Methods A total of 94 hypertension patients with coronary heart disease in the hospital from January 2020 to August 2022 were selected and randomly divided into two groups,with 47 cases in each group.Control group was treated with conventional treatment,while observation group was treated with individualized treatment under non-invasive cardiac output measurement,and both group were continuously treated for 3 months.Clinical efficacy,the blood pressure control[diastolic blood pressure(DBP),systolic blood pressure(SBP)],cardiac ultrasound parameters[left ventricular end-systolic diameter(LVESD),left ventricular mass index(LVMI),interventricular septal thickness(IVS),left ventricular end-diastolic diameter(LVEDD)],heart rate variability[the standard deviation of the average RR interval(SDANN),the standard deviation of the RR interval of all sinus beats(SDNN),and the proportion of adjacent NN>50 ms in the number of sinus beats(PNN50)],indicators of myocardial injury[α-hydroxybutyrate dehydrogenase(α-HBDH),lactate dehydrogenase(LDH),creatine kinase(CK)],transforming growth factor-β1(TGF-β1)/pancreatic cancer-deficiency factor(Smads)signaling pathway,and incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results The total effective rate of the observation group was 95.74%,which showed no significant difference compared with 85.11%of the control group(P>0.05).After 1 and 3 months of treatment,the levels of DBP and SBP in both groups were decreased significantly compared with those before treatment(P<0.05),and the LVMI,IVS,LVEDD and LVESD in the observation group were significantly lower than those in the control group(P<0.05).After 3 months of treatment,the SDANN,PNN50 and SDNN in observation group were significantly higher than those in control group(P<0.05),while CK,α-HBDH and LDH as well as the

关 键 词：高血压 冠心病 无创心输出量测量 个体化治疗方案 血压 心率变异性 心肌损伤 主要不良心血管事件 

分 类 号：R544.1[医药卫生—心血管疾病] R541.4[医药卫生—内科学] R45[医药卫生—临床医学]