瑞舒伐他汀对高血压合并动脉粥样硬化患者内皮功能及内皮型氧化亚氮合酶基因表达的影响

Influences of rosuvastatin on the endothelial function and eNOS gene expression in patients with hypertension combined with atherosclerosis

目的探讨瑞舒伐他汀对高血压合并动脉粥样硬化患者内皮功能及内皮型氧化亚氮合酶(eNOS)基因表达的影响。方法选取50例合并颈动脉斑块的高血压患者作为研究组,25例无颈动脉斑块的高血压患者作为对照组。对照组维持原有降压方案不变,研究组在原有方案基础上予以瑞舒伐他汀。比较2组治疗前彩色多普勒超声和血清学检查结果,观察研究组治疗前后颈动脉硬化指标、血管舒张功能(FMD)及相关血清学指标的变化及eNOS mRNA表达情况。结果治疗前,研究组颈动脉内膜中层厚度(IMT)、高敏C反应蛋白(hs-CRP)水平显著高于对照组,而超氧化物歧化酶(SOD)、FMD及氧化亚氮(NO)显著低于对照组;研究组治疗后颈动脉IMT和斑块积分较治疗前明显缩小,FMD改善,SOD、NO升高,hs-CRP、甘油三酯(TG)、总胆固醇(TC)及低密度脂蛋白(LDL-C)明显降低;Pearson相关分析表明,研究组治疗前FMD与SOD、NO成正相关,与IMT、hs-CRP、收缩压(SBP)、TC成负相关;治疗后,研究组eNOS/磷酸甘油醛脱氢酶(GAPDH)灰度值较治疗前明显下降。结论合并动脉粥样硬化的高血压患者内皮功能障碍较重,内皮功能与多种心血管危险因素相关,瑞舒伐他汀可通过增强eNOS基因表达来改善内皮功能,稳定动脉斑块。

Objective To investigate influences of rosuvastatin on the endothelial function and endothelial nitric oxide synthase （eNOS） gene expression in patients with hypertension com- bined with atherosclerosis. Methods Fifty hypertensive patients with carotid atherosclerosis were selected as research group, 25 hypertensive patients without carotid atherosclerosis were as control group. The control group continued to receive the former regimen to decrease blood pressure, while research group was adminstered rosuvastatin based on the former regimen. The results of color doppler ultrasound and serological testing in two groups were compared, and carotid atherosclerosis indexes and flow-mediated vasodilation （FMD） before and after treatment as well as changes of sero- logical indexes and eNOS mRNA expression were observed. Results Before treatment, carotid in- tima-media thickness （IMT） and hypersensitivity C reactive protein （hs-CRP） level in the research group were significantly higher than those in the control group, while superoxide dismutase （SOD）, FMD and nitric oxide （NO） were markedly lower than those in the control group. After treatment, carotid IMT and plaque score in the research group were obviously lessened compared with those pri- or to treatment. FMD improved, SOD and NO increased, and hs-CRP, triglyeerides （TG）, TC （total cholesterol） and low-density lipoprotein cholesterol （LDL-C） obviously decreased. Pearson- related analysis demonstrated that FMD was positively associated with SOD and NO in the research group before treatment , while negatively associated with IMT , hs - CRP , systolic bloodpressure （SBP） and TC. The grey value of eNOS/phosphoglyceraldehyde dehydrogenase （GAPDH） after treatment in the research group notably decreased compared with those prior to treatment. Con- elusion The hypertensive patients with atherosclerosis have sever endothelial functional disorder, but endothelial function are related to various cardiovascular risk factors. Rosuvastatin can im- prove endothelial function and stabilize artery plaques by reinforcement of eNOS gene expression.