血清胆红素水平与高血压患者动脉弹性和左室肥厚的关系以及长期服用氨氯地平的疗效

Study on influences of serum bilirubin and the effects of long-term treatment with amlodipine on arterial elasticity and left ventricular hypertrophy in hypertensive patients

目的探讨高血压病患者正常血清胆红素水平内不同胆红素水平与动脉弹性及左室肥厚(LVH)的关系,以及长期服用氨氯地平的疗效。方法以全自动生化分析仪测定79例高血压病患者血清胆红素水平,利用动脉弹性功能测定仪检测动脉弹性,利用超声心动图(UCG)检测左室质量指数(LV-MI),按照血清总胆红素(TBil)水平将79例患者分为两组,即低血清胆红素水平组,A组,48例;高血清胆红素水平组,B组,31例。患者连续服用氨氯地平36个月,比较两组动脉弹性和LVMI的变化。结果79例患者血清TBil水平均在正常范围内,A、B两组TBil分别为(7.8±1.8)μmol/L和(14.3±1.7)μmol/L,两组TBil比较,(P<0.01)。服用氨氯地平8周后血压能控制在140/90mmHg以下且保持平稳。A组治疗前小动脉弹性指数(C2)明显低于B组(P<0.05),治疗后两组C2逐渐增加,A组在治疗24个月时即出现显著改善,两组均在治疗36个月时较治疗前有显著增加;治疗前A组LVMI高于B组,但无显著统计学意义,治疗后为两组LVMI逐渐降低,A组治疗前与治疗36个月后比较,P<0.05,B组治疗前后LVMI比较无显著统计学意义。结论血清胆红素水平与血管损伤呈反相关。钙通道阻滞剂氨氯地平在平稳降压的同时,能恢复受损的动脉血管弹性,改善血管功能,减轻LVH。

Objective To investigate the relationship between the level of serum bilirubin and degree of arterial injury,and to evaluate the clinical effects of long-term treatment with amlodipine on arterial elasticity and left ventricular hypertrophy(LVH)in hypertensive patients.Methods Serum bilirubin levels were measured by automatic chemical analyzer.The arterial elasticity indexes of the hypertensive patients(79 cases)were detected with CVProfilor DO-2020,and left ventricular mass indexes(LVMI)were measured with ultrasound cardiography(UCG)before and after long-term(36 months)treatment with amlodipine.The hypertensive patients were divided into 2 groups according to the level of serum total bilirubin(TBil).Group A with lower level of TBil,n=48;Group B with higher level of TBil,n=31.Results The blood pressure was controlled to therapeutic aim and maintained stable after 8-week treatment with amlodipine.The serum levels of TBil in 79 cases of hypertensive patients ranged normally,but the level of TBil in group A(7.8±1.8)μmol/L was significantly lower than that in group B(14.3±1.7)μmol/L (P<0.01).The small artery elasticity index(C2)in group A decreased dramatically than that in group B.C2 rised progressively in 2 groups after treatment with amlodipine,and showed significance in group A after 24-month therapy,there were notable increases in 2 groups after 36-month therapy.LVMI in group A was higher than that in group B,but it didn’t show any remarkable differences,LVMI lightened progressively in 2 groups,and it lightened dramatically after 36-month therapy in group A,didn’t show remarkable changes in group B after therapy.Conclusion Bilirubin is a valid protector of blood vessels.Amlodipine can improve arterial elasticity and vascular function,lighten LVH,while lowering blood pressure stably.