摘要
目的 观察在同等控制血压前提下血管紧张素转换酶抑制剂 (ACEI)加安体舒通对心脏胶原更新的影响。方法 临床研究随机入选原发性高血压患者 13 5人 ,随机分入A(ACEI +安体舒通 )、B(ACEI)、C[非肾素血管紧张素醛固酮系统 (RAAS)干预治疗 ]三组 ,观察一年 ,比较三种治疗方案对心肌胶原更新的影响。动物实验使用肾动脉上腹主动脉次全结扎高血压心肌肥厚模型SD大鼠 48只 ,随机分为A(ACEI +安体舒通 )、B(ACEI)、C(空白对照 )、D(伪手术 )四组 ,治疗 2个月 ,从病理上验证ACEI加安体舒通对心脏胶原更新的影响。结果 临床研究显示在同等控制血压的前提下 ,减低血清PⅢNP的疗效 ,ACEI联合抗醛固酮治疗优于单纯ACEI治疗 ,两者均优于非RAAS干预治疗。动物研究显示ACEI联合抗醛固酮治疗使心肌间质胶原沉积明显减低。结论 ACEI联合抗醛固酮治疗比单纯ACEI治疗更好的减低血清PⅢNP ,并使心肌间质胶原沉积明显减低 。
Objective To evaluate the effects of ACEI combined with spi ronolactone(SP) on amino-terminal propertied type Ⅲ procollagen(PⅢNP), the marker of collagen turnover, and the histological changes in myocardial fibrosis. Method One hundred thirty five patients with hypertension w ere recruited and randomly assigned to receive enalapril (20 mg/d) combined with SP(20 mg/d)(group A), or enalapril (20 mg/d) alone (group B) for 12 months. A control group of patients received conventional antihypertensive drugs without affecting RAAS(group C). Hypertension model were created in SD rats by constricting the abdominal aorta above renal arteries. Forty-eight SD were divided into 4 groups: ACEI+SP treatment(group A), ACEI treatment alone(group B), control (group C) and sham operation (group D). After 2 months treatment, the myocardial interstitial collagen deposition in experimental animals was studied to verify the effect of combination of ACEI and SP. Results ACEI combined with SP significantly decreased plasma PⅢNP in patients with h ypertension than that in the patients receiving ACEI alone(combined: form 3.8±0 2 to 2 3±0 2 μg/L; alone: from 3 7±0 3 to 3 4±0 3 μg/L, P<0 05) Th e combination also decreased myocardial interstitial collagen deposition much more pronouncedly than ACEI alone. Conclusion A low dose of spironolactone combined with ACEI in hibit the collagen deposition in myocardium in patients with hypertension, manifested by decreases in plasma PⅢNP, which was confirmed by histological examination in experimental animal study.
出处
《高血压杂志》
CSCD
2003年第6期579-582,共4页
Chinese Journal of Hypertension
基金
十五"军聚集科研基金资助项目 ( 0 1Q0 56 )
