老年高血压危险度分层与抗心磷脂抗体的关系及缬沙坦的药物干预治疗

The relationship between anticardiolipin antibody and elderly patients with essential hypertension and the therape of valsarta

目的观察不同危险度分层的老年高血压患者血清中抗心磷脂抗体（ACLA）的结合指数（BI）的变化，了解ACLA在高血压发生发展中的临床意义及缬沙坦对老年高血压患者血管内皮功能的影响。方法采用酶联免疫吸附法检测2004年1月至2007年1月在南昌大学第一附属医院干部病房住院及门诊就诊的年龄〉160岁的120例高血压患者和30名健康者以及20名年龄〈60岁健康者ACLA的BI，对不同危险度分层的老年高血压患者ACLA的BI进行比较。对患病组60例患者予以缬沙坦80—160mg／d干预治疗6周，观察缬沙坦对高血压患者ACLA的疗效。结果老年高血压中危、高危、极高危组ACLA的BI与健康组、低危组比较明显升高，差异有显著性意义（P〈0．05，P〈0．01），低危组与健康对照组ACLA的BI比较，差异无显著性意义（P〉0．05），年龄〉175岁与年龄〈75岁的两组健康者ACLA的BI比较，差异有显著性意义（P〈0．05）。经缬沙坦80—160mg／d治疗6周后，各组患者血压降至正常范围，其中老年高血压中危、高危、极高危组ACLA的BI较治疗前降低，差异有显著性意义（P〈0．05，P〈0．01），且危险程度越高，ACLA的BI下降越显著。结论高血压患者可能存在自身免疫，ACLA的测定对预测高血压病情轻重及并发症的发生有一定的临床意义。缬沙坦降压疗效显著，能改善高血压引起的内皮功能损害。

Objective To study anticardiolipin antibody（ACLA） in elderly patients with essential hypertension（EH） and to investigate the influence of valsarta on the function of vascular endothelium. Methods The levels of ACLA were measured by an enzyme-linked immunoabsorbent assay in 120 patients with EH and 30 healthy controls. All parameters were compared in the EH patients with different stratification. Sixty elderly hypertension patients were treated with valsarta for 6 weeks of with the dose range from 80 to 160 mg/d and compared with 60 healthy elderly people before and after treatment by measuring the levels of ACLA. Results The concentration of ACLA were significantly higher in patients with risk, higher risk and very high risk group than those in healthy control group and patients with low risk group（P 〈0. 05 ,P 〈 0. 01 ）. There was no significant difference between the patients with low risk group and healthy control group（ P 〉 0. 05 ）. After 6 weeks of treatment with valsarta, systolic and diastolic pressures remarkably decreased and the levels of ACLA were decreased significantly; the higher the degree, the more notable the change of ACLA. Conclusion The patients with EH might have self-immunity. The results suggest that circulating ACLA might have clinical significance in forecasting the severity of EH. Valsarta is effective in treating hypertension ,which may improve the function of vascular endothelium.