高血压患者内皮功能与左心室肥厚的关系及左旋氨氯地平的干预作用

Correlation of endothelial function and left ventricular hypertrophy in patients with essential hypertension and effect of levamlodipine on them

目的研究轻、中度原发性高血压(高血压)患者内皮功能与左心室肥厚的关系以及左旋氨氯地平对其的干预作用。方法测定62例新发和(或)未经治疗的轻、中度高血压患者的收缩压、舒张压、心率和血清肌酐、丙氨酸氨基转移酶、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白、空腹血糖和2 h血糖以及一氧化氮、内皮素-1浓度;同时测定超声心动图指标并计算左心室质量指数。根据左心室质量指数分为左心室肥厚组(30例)和非肥厚组(32例),同时选择同期健康体检的27名正常者作为对照组。高血压患者均给予左旋氨氯地平2.5 mg/d治疗,随访1年。高血压组各观察指标治疗8周及1年后测量并与治疗前进行比较。结果(1)高血压组血清三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白和内皮素-1浓度均显著高于对照组,一氧化氮则显著低于对照组,差异有统计学意义(P<0.05)。(2)治疗8周后,高血压组收缩压、舒张压及血清总胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白、内皮素-1浓度均较治疗前显著降低,一氧化氮浓度升高,差异具有统计学意义(P<0.05)。(3)左心室肥厚组血清内皮素-1浓度显著高于非肥厚组,一氧化氮浓度显著低于非肥厚组,差异具有统计学意义(P<0.05)。(4)Pearson相关分析结果:高血压患者血清一氧化氮浓度与室间隔厚度(r=-0.258,P<0.05)及左心室质量指数(r=-0.301,P<0.05)负相关;血清内皮素-1浓度与左心室后壁厚度(r=0.253,P<0.05)呈正相关。(5)治疗1年后,高血压组舒张及收缩功能与治疗前比较,差异无统计学意义(P>0.05),左心室质量指数明显下降,差异有统计学意义(P<0.05)。结论高血压患者存在内皮功能受损,左心室肥厚患者更为严重,其内皮功能与左心室肥厚具有相关性。左旋氨氯地平可以改善血管内皮功能和逆转左心室肥厚。

Objectives To investigate the relationship of endothelial function and left ventricular hypertrophy （LVH） in patients with mild to moderate essential hypertension （EH）, and the effect of levamlodipine on endothelial function and LVH. Methods 62 patients with mild to moderate EH who were newly diagnosed and （or） untreated were enrolled. Systolic blood pressure,diastolic blood pressure,heart rate and serum concentrations of creatinine,alanine aminotransferase, trlglyeride, total cholesterol, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C）, high-sensitivity C-reactive protein （hsCRP）, fasting blood glucose, 2 h blood glucose, nitric oxide and endothelin-1, and noninvasive echocardiography were measured. Left ventricular mass index （LVMI） was then calculated. Patients with EH were divided into two groups according to LVMI： LVH group （n=30） and non-LVH group （n=32）. Meanwhile, 27 healthy subjects were selected as control group. Patients with EH were treated with levamlodipine （2.5 rag/d） and followed up for 1 year. Variables in patients with EH were measured before treatment and 8 weeks,1 year after treatment and compared. Results hsCRP and endothelin-1 in patients with EH （1） were Serum concentrations of triglyeride, total cholesterol, LDL-C, significantly higher than those in control group, but serum concentration of nitric oxide was significantly lower （P〈0.05）. （2） After 8 weeks＇ treatment, systolic blood pressure, diastolic blood pressure and serum concentrations of total cholesterol, LDL-C, hsCRP, endothelin-1 in EH group were significantly lower than those before treatment, while serum concentration of nitric oxide was significantly higher （P〈 0.05）. （3） Serum concentration of endothelin-I in LVH group was significantly higher than that in non-LVH group, and serum concentration of nitric oxide was significantly lower（P〈0.05 ）. （4） Pearson correlation analysis indicated that serum eoneentration of nitric oxide in patients with EH was negatively correlated with interventricular septal thickness （r=-0.258, P〈0.05） and LVMI （r=-0.301, P〈0.05）; serum concentration of endothelin-1 was positively correlated with left ventricular posterior wall thickness （r=0.253, P〈0.05）. （5） After 1 year＇s treatment, there was no significant difference of diastolic function and systolic function in EH group compared to those before treatment （P〉0.05）, but LVMI obviously decreased （P〈0.05）. Conclusions Endothelial dysfunction is found in patients with EH, espeeially in LVH patients. Endothelial function is related to LVH. Levamlodipine can improve endothelial dysfunction and deteriorate LVH.