乌拉地尔对围术期高血压患者血浆心血管活性肽的影响

The Effect of Urapidil on the Changes of Plasma Neuropeptide Levels in Pa-tients with Hypertension before Operation

目的:探讨高血压患者血浆神经肽Y（NPY）,内皮素（ET）,神经降压素（NT）,降钙素基因相关肽（CGRP）与平均动脉压（MAP）的关系;观察乌拉地尔（URA）对诸指标的影响;探讨心血管活性肽变化在URA降压机制中的作用。方法:麻醉前高血压患者40例。用放射免疫分析方法测定血浆NPY,ET,NT,CGRP水平并与40例健康者作对照;采用自身对照方法观察高血压患者URA（0.4～0.6mg·kg-1）静脉注射后4种心血管活性肽水平及血压变化;应用SAS软件行统计学分析。结果:高血压患者NPY（228.73±87.27ng/L）,ET（60.81±14.47ng/L）显著高于正常对照组（分别是91.33±41.74ng/L和36.99±12.52mg/L,均P<0.001）;NT（42.18±14.27ng/L）显著低于正常对照组（85.97±42.97ng/L,P<0.001）。多元逐步回归分析发现NPY对高血压患者MAP作用最为显著（Y=15.549+0.0099X3）。URA治疗后高血压患者血浆NPY（104.07±67.79ng/L）,ET（47.33±16.48ng/L）水平显著下降（均P<0.001）;血浆NT（74.51±29.45ng/L）,CGRP（3.15±10.21ng/L,水平显著升高（均P<0.001）。结论:NPY可能在高血压发生、发展中起重要作用。URA的降压机制中可能与血浆NPY、ET水平下降,CGRP、NT水平升高有关。

Objective: To investigate the relation between the mean artery pressure (MAP) and the levels of neuropeptide Y (NPY), endothelin (ET), neurotensin (NT) and calcitonin gene-related peptide (CGRP) in patients with hypertension. To study the effect of urapidil (URA) on plasma neuropeptides and their changes on blood presure. Methods: 40 patients with hy-pertension and 40 health humans as control were studied. Plasma samples were drawn before and 15 minutes after administra-tion of URA 0.4mg·kg-1 to 0. 6 mg·kg-1 intravenously. The neuropeptides were meassured with radioimmunoassay. Re-sults: Compared with control group ( NPY 91. 33± 41. 74ng/L and ET 36.99±12. 52ng/L), the levels of NPY(228. 73± 87.27ng/L)and ET(60.81±814.47ng/L)increased markedly in the patients with hypertension (P<0.001);NT(42. 18± 14.27ng/L) levels decreased significantly (P<0.001)than control group (85.97±42.97ng/L P<0.001). Mutivariate gradu-ally regression analysis saggested that NPY had the remarkable effect on MAP in patients with hypertension (Y=15. 549± 0.0099X3). After urapidil administration, the of NPY(104.07±67.79ng/L), ET(47.33±16.48ng/L) decreased significant-ly (P<0.001).The levels of NT(74. 51±29.45ng/L),GRP(36.1.15±10.21ng/L) increased significantly than that in control group (P<0.001). Conclusion: NPY may be an important cause of essential hypertension. The mechanism of decreasing hyper-tension effects of urapidil may be relationship with the decreasing of plasma levels of NPY and ET, and the increasing of plasma levels of NT and CGRP.