螺内酯对伴左心室肥厚的原发性高血压患者心肌胶原纤维代谢的影响

Effects of spironolactone on myocardial collagen metabolism in patients with essential hypertension accompanied with left ventricle hypertrophy

目的观察在常规抗高血压治疗的基础上联合应用螺内酯对伴左心室肥厚的原发性高血压(EH)患者血清Ⅰ型前胶原羧基端肽(PⅠCP)、Ⅲ型前胶原氨基端肽(PⅢNP)和左心室质量指数(LVMI)的改变,了解螺内酯对EH患者心肌胶原纤维代谢的影响。方法71例伴左心室肥厚的EH患者随机分为2组。常规治疗组35例,接受钙离子阻滞剂、β受体阻滞剂、ACEI和抗血小板药物等常规药物治疗。螺内酯组36例,在常规药物治疗基础上联合应用螺内酯。2组的治疗时间均为24周。测量治疗前及治疗24周时血清PⅠCP、PⅢNP和LVMI。33例健康人作为对照组。结果与对照组比较,常规治疗组和螺内酯组治疗前的PⅠCP、PⅢNP和LVMI均明显增高,差异均有显著性(P<0.01)。常规治疗组和螺内酯组治疗后与治疗前比较PⅠCP、PⅢNP和LVMI均明显下降(P<0.05和0.01),但螺内酯组下降更为明显,各指标差异均有显著性(P<0.05)。在观察期间,常规治疗组和螺内酯组患者血钠、血氯、血肌酐和丙氨酸氨基转移酶水平均无明显变化。结论在常规抗高血压治疗的基础上联合应用螺内酯能进一步降低伴左心室肥厚的EH患者血清PⅠCP和PⅢNP水平以及LVMI,副作用轻,是安全、有效、更理想的高血压治疗方法。

Objective To observe the changes of the serum concentrations of the carboxyterminal propeptide of type Ⅰ proeollagen （ PⅠCP）, aminoterminal propeptide of type Ⅲ precollagen （ P Ⅲ NP） and the left ventricle mass index （LVMI）, and to evaluate the effects of spironolactone on myocardial collagen metabolism in patients with essential hypertension with left ventricle hypertrophy. Methods 71 patients with essential hypertension accompanied with left ventricle hypertrophy were randomly divided into two groups. Convention group （ n = 35 ） received calcinium onion blocker, β-blocker, angiotensin-converting enzyme inhibitor （ ACEI ） and anti-plaque agent. Spironolactone group （ n = 36 ） received conventional treatment plus spironolactone. Before treatment and on the 24th week the serum concentrations of P Ⅰ CP and P Ⅲ NP were determined by the radio immunologic method and echoeardiography was conducted to determine LVMI. 33 healthy people served as control group. Results The serum concentrations of P Ⅰ CP,P Ⅲ NP and the LVMI in conventional group and spironolactone group were significantly higher than those in control group （P 〈 0.01 ）. The serum concentrations of P Ⅰ CP,P Ⅲ NP and the LVMI on the 24th week were significandy increased compared to those before treatment both in conventional group and spironolactone group （ P 〈 0.05 or 0.01 ） ,and all the variables were much lower in spironolactone group （P 〈 0.05 ）. The serum concentrations of natrium, potassium, creatinine and alanine aminotransferase were not significantly changed in these two groups. Conelnsion Spironolactone in combination with the conventional treatment may further decrease the serum concentrations of PⅠCP,PⅢ NP and the LVMI in patients with essential hypertension accompanied with left ventricle hypertrophy,with light side effects. It is a safe,effective and more perfect treatment protocol.