螺内酯联合咪哒普利对原发性高血压并左室肥厚患者血清Ⅲ型前胶原含量和左室肥厚的影响

Effects of spironolactone in conjunction with imidapril on circulating procollagen Ⅲ and left ventricle hypertrophy in patients with essential hypertension and left ventricle hypertrophy

目的:观察螺内酯联合咪哒普利治疗对高血压病患者血清Ⅲ型前胶原含量和左室肥厚的影响。方法:轻中度原发性高血压并左室肥厚患者150例,随机分为3组,每组50例,咪哒普利+螺内酯组(A组)、咪哒普利组(B组)及β受体阻滞剂或钙离子拮抗剂组(C组),治疗6个月,目标血压<130/80mmHg。治疗前后测定血清Ⅲ型前胶原含量,心脏超声测定左室质量指数(LVMI),舒张早期最大血流速度(E)与舒张晚期最大血流速度(A),计算E/A比值。结果:3组均同等有效地控制血压。治疗前A、B、C组血清Ⅲ型前胶原含量分别为(178.1±28.6),(169.0±19.7)和(175.5±21.3)mg/L,治疗后分别为(93.4±23.5),(115.7±17.6)和(169.5±31.7)mg/L,A、B组治疗后血清Ⅲ型前胶原含量均较治疗前明显下降,且A组低于B、C组(F组间=265.71,F时间=30.69,P<0.05)。3组治疗后左室肥厚相关指标均有改善,且A组优于B、C组(LVMI:F组间=137.46,F时间=10.47,P<0.05;E/A:F组间=98.74,F时间=20.17,P<0.05)。结论:小剂量螺内酯与咪哒普利联用可以降低血清Ⅲ型前胶原含量,从而改善重构,且该作用不依赖于血压下降。

Aim:To explore the effects of spironolactone in conjunction with anangiotensin converting enzyme inhibitor imidapril on circulating procollagen Ⅲ and left ventricle hypertrophy(LVH) in patients with essential hypertension and LVH.Methods:A total of 150 mild to moderate hypertensive patients with LVH were randomly assigned to receive imidapril plus spironolactone(group A),imidapril(group B) and calcium antagonist or beta blocker(group C) for six months. Target blood pressure was<130/80 mmHg.The serum procoll...