福辛普利和吲哒帕胺对高血压病患者胶原代谢的影响

Effects of fosinopril and indapamide on accumulation of myocardium collagen in patients with mild to moderate essential hypertension

目的通过研究高血压病患者治疗前后胶原合成与分解的相关指标，探讨口服降压药物干预心肌基质胶原沉积的机制。方法原发性高血压病患者92例，健康对照组39例。测量血压、心率、体重指数、腰臀比等。高血压病患者随机分为单用福辛普利组（F组）和福辛普利＋吲哒帕胺组（Ⅱ组），随访观察12-16个月。治疗前及观察结束时留取血清，酶联免疫吸附法（FLISA）检测金属蛋白酶-1（MMP-1），放射免疫法检测Ⅲ型前胶原前肽（PⅢNP）。结果治疗前原发性高血压病患者MMP-1显著低于健康对照组[（5．35±4．17）ng/ml和（6．40±3．55）ng/ml，t=2．405，P=0．041]，治疗前PⅢNP显著高于对照组[（3．67±1．37）μg/L和（2．65±1．07）μg/L，t=-3．479，P=0．001]。F组治疗前后MMP-1差异无统计学意义（t=-0．493，P=0．626），PⅢNP改变也无统计学意义（t=0．836，P=0.411）。FI组患者治疗后MMP-1升高[从（4．03±3．04）ng/ml到（6．59±3．79）ng／ml，t=-3．512，P=0．002）]，PⅢNP下降[从（3．64±1．14）μg/L到（3．06±1．11）μg/L，t=2．019，P=0．04]。结论防止心肌基质胶原沉积除抑制RAAS系统等神经体液因素外，达到降压靶目标也是主要治疗方向。

Objeetive To view the influence of chronic drug therapy on accumulation of myocardium collagen in hypertensive patients. Methods ninety-two hypertensive patients with age of （52.1 ± 7.9） years and thirty-nine health control with age of （53.4 ± 7.6） years were enrolled.Blood pressure （BP）,heart rate （HR）,body mass index （BMI） and waist/hip ratio （WHR） were measured. Patients were assigned to fosinopril or fosinopfil ＋ indapamide group after randomization. This follow up study continued for 12 -16 months.Serum matrix metalloproteinase-1 concentration was determined by enzyme-linked immuno-sorbent assay （ELISA）, and serum N-terminal propeptide of type Ⅲ procollagen concentration was determined by specific radioimmunoassay. Results MMP-1 of hypertensive patients before remedy differed greatly from that of health control [ （ 5.35 ± 4.17） ng/ml versus （6.40 ± 3.55） ng/ml, t = 2.405, P = 0.041 ]. P Ⅲ NP of hypertensive patients before therapy were much higher than that of health control [ （3.67 ± 1.37）μg/L versus （2.65 ± 1.07）lzg/L, t = - 3.479, P = 0.001 ]. Neither MMP-1 nor PⅢ NP changed significantly in fosinopril-treated patients. In fosinopril ＋ indapamide-treated patients, the concentration of MMP-1 increased significantly [from （4.03 ± 3.04）ng/ml to （6.59 ± 3.79）ng/ml, t = - 3.521, P = 0.002], the concentration of PIll NP decreased significantly[from （3.64 ± 1.14 ） μg/L to （3.06 ± 1.11 ） μg/L, t = 2.019, P = 0.04 ]. Conclusion The present study suggested that the efficacy of chronic combined therapy with fosinopril ＋ indapamide in lowering blood pressure of hypertensive patients is superior to fosinopril monotherapy. The efficient of prohibition accumulation of myocardium collagen with fosinopril ＋ indapamide is superior to fosinopril monotherapy.