高血压患者凝血、纤溶活性变化及硝苯地平缓释剂对它的影响

Coagulative and fibrinolytic changes in patients with essential hypertension and the effect of sustained-release nifedipine

目的观察高血压病(EH)患者血液凝血、纤溶活性变化以及硝苯地平缓释剂对它的影响。方法99例EH患者,按舒张压水平分为轻度48例、中度29例、重度22例,其中随机给25例患者口服硝苯地平缓释剂治疗2周。设健康对照组20例。采用酶联免疫吸附双抗夹心法测定其血浆D-二聚体(DD)、纤维蛋白单体(FM)和组织型纤溶酶原激活剂(tPA)含量。结果EH患者的血浆DD、FM浓度较对照组明显升高,tPA浓度显著下降,且随EH程度加重而显著变化。舒张压与FM呈显著正相关(r=0.374,P<0.001)。EH伴左心室和左心房肥大者的血浆DD、FM和tPA浓度均明显升高。25例经硝苯地平缓释剂治疗患者血浆DD、FM浓度显著下降(P<0.001),而tPA浓度显著升高(P<0.01)。结论EH患者的血液凝血活性明显增强,纤溶活性显著下降,硝苯地平缓释剂可改善EH患者的凝血和纤溶功能失调。

Objective To investigatethechangesof coagulationandfibrinolysisstatusinpatientswithessentialhypertension(EH)andobservethetherapeuticeffectof sustained-releasenifedipine.Methods Ninety-nineEH patientsweredivided accordingto theirdiastolicbloodpressure (DBP)intomildgroup(48cases),moderategroup(29cases)andseveregroup(22cases),and25patientsamongthegroupswerechosenat randomto receive sustained-releasenifedipinefor2weeks.Twenty healthysubjectsservedas controlgroup.PlasmaD-dimer(DD),fibrinmonomer(FM)andtissue-typeplasminogenactivitor(tPA)levelsweredeterminedin allthesubjectsby enzyme-linkedimmunosorbentassay(ELISA).Results TheplasmaDD andFMlevelsweremuchhigher,whiletPAlevelwasmuchlowerinhypertensivesthanthoseof normalcontrols,exacerbating withtheseverityof thedisease.DBPwas positivelycorrelatedwithplasmaFM level(r=0.374,P<0.001).In patientswithleft ventricularhypertrophy,leftventriuclarenlargementandleftatrialenlargement,higherlevelsof DD,FM andtPAwere detected.Nifedipinetreatmentproducedsignificantreductionin plasmaDD andFM levels alongwiththeincreasein tPA level [DD:(40.7±23.5)mg/dlvs(23.8±16.5)mg/dl;FM:(7.0±1.6)ng/μl vs(4.8±1.5)ng/μl;tPA:(0.31±0.14)ng/mlvs(0.41±0.05)ng/ml,P<0.001].Conclusion EnahncedcoagulativeactivityandloweredfibrinolyticactivitycharacterizeEHpatients andnifedipinemaycorrect thisdisorder.