福辛普利和复方降压片对高血压患者胶原代谢的影响

Effects of fosinopril and compound antihypertensive tablet on collagen metabolism in patients with mild tomoderate essential hypertension

目的本研究通过观察原发性高血压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。方法原发性高血压患者83例，男35例，女48例，年龄30—70岁，平均（52．1±7．9）岁。健康对照组39例，男15例，女24例，年龄33～70岁，平均（53．4±7．6）岁。测量血压、心率、体重指数（body mass index，BMI）、腰臀比（waist／hipratio，WHR）等。高血压患者随机服用复方降压片或福辛普利，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（ELISA）检测金属蛋白酶-1（matrix metalloproteinase-1，MMP-1），放射免疫法检测Ⅲ型前胶原前肽（N-terminal propeptide of type Ⅲ procollagen，PⅢNP）。结果治疗前原发性高血压患者MMP-1显著低于健康对照组（5．35±4．17μg·L^-1vs6．40±3．55μg·L^-1，P=0．041），治疗前PⅢNP显著高于对照组（3．67±1．37μg·L^-1vs2．65±1．07μg·L^-1，P=0．001）。福辛普利组治疗前后MMP-1无统计学改变（P=0．626），PⅢNP无统计学改变（P=0．411）。用复方降压片组患者治疗后MMP-1升高（从4．87±3．76μg·L^-1到7．37±4．41μg·L^-1，P=0．001），PⅢNP下降（从4．07±1．13μg·L^-1到3．29±1．40μg·L^-1，P=0．021）。结论防止心肌基质胶原沉积除抑制RAAS系统和去甲肾上腺素等神经体液因素外，达到降压靶目标也是主要治疗方向。

Aim To view the influence of chronic drug therapy on accumulation of myocardium collagen in hypertensive patients. Methods Eighty-three 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 compound antihypertensive tablet or fosinopril 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 μg·L^-1verses 6.40±3.55 μg·L^-1 ,P =0. 041 ）. PⅢ NP of hypertensive patients before therapy were much higher than that of health control（3.67 ± 1.37 μg·L^-1 verses 2.65 ± 1.07 μg·L^-1 ,P = 0. 001 ）. Neither MMP-1 nor PⅢ NP changed significantly in foSinopril-treated patients. In compound antihypertensive tablet -treated patients,while the concentration of MMP-1 increased significandy（from 4.87 ±3.76 μg·L^-1 to 7.37 ±4.41 μg·L^-1 ,P = 0. 001 ） while the concentration of PⅢ NP decreased significantly（ from 4.07 ±1.13 μg·L^-1 to 3.29 ±1.40 μg·L^-1 ,p = 0.021 ）. Conclusion The present study suggested that the efficacy of chronic combined therapy with compound antihypertensive tablet in lowering blood pressure of hypertensive patients was superior to fosinopril monotherapy. The efficiency of prohibition accumulation of myocardium collagen with compound antihypertensive tablet was superior to fosinopril monotherapy.