高血压病患者缬沙坦治疗前后血清PCⅢ浓度的变化及意义

Variation of serum PCⅢ and its clinical significance in patients with essential hypertension before and after treatment with valsartan

目的评价缬沙坦对高血压心肌纤维化及左室舒张功能的影响。方法用放免法、超声心动图检查了16例高血压左室肥厚患者(LVH组)、18例高血压无左室肥厚患者(NLVH组)缬沙坦治疗前后血清中Ⅲ型前胶原(PCⅢ)、血浆血管紧张素Ⅱ(AngⅡ)水平及左室舒张功能指标的变化,并与15例健康对照者进行比较。结果治疗前NLVH组及LVH组的血清PCⅢ、AngⅡ水平均较对照组升高(P<0.05或<0.01);用药前后比较,NLVH组及LVH组血清PCⅢ水平明显下降,AngⅡ水平明显升高(P均<0.05)。高血压患者血清PCⅢ水平与SBP、DBP、LVM I呈明显正相关(r=0.587、0.514、0.825,P均<0.05);与左室舒张功能指标E/A呈明显负相关(r=-0.762,P<0.05)。结论血清PCⅢ水平是反映高血压病患者心肌胶原合成活跃程度与心肌纤维化的敏感、早期指标。缬沙坦有助于减轻心肌纤维化的程度,改善左室舒张功能。

Objective To evaluate the impact of valsartan on myocardium fibrosis and left ventricular diastolic function in essential hypertensions （EH） . Methods Serum levels of PCⅢ, AngⅡ and left diastolic function parameters in 16hypertension accompanied with left ventricular hypertrophy patients （LVH group） and 18 hypertension without left ventricular hypertrophy patients （ NLVH group） were detected by doppler echocardiogram and radioimmunology analyses before and after valsartan treatment, and compared with 15 healthy volunteers （control group）. Results Serum levels of PCⅢ and AngⅡ increased in hypertensive patients as compared with normotensive subjects before valsartan treatment （ P 〈 0.05, P 〈 0.01 ）. After treatment, the serum PCⅢ level in patients of 2 groups were decreased （ P 〈 0.05 ） , and AngⅡ level was increased （P 〈0.05）. PCⅢ level positively correlated with the SBP, DBP, LVMI （r = 0. 587, 0. 514, 0. 825, P 〈 0. 05）, and inversely correlates with the ratio of E/A （r = - 0. 762, P 〈 0.05）. Conclusions Serum PCⅢ level is an useful marker in reflecting the degree of cardiac muscle collogen synthesis and myocardial fibrosis associated with hypertension. Valsartan may ameliorate the left ventricular diastolic function and prevent myocardium fibrosis.