缬沙坦改善高血压患者左室重构的研究及对MMP-9、TIMP-1的影响

Effects of Valsartan on left ventricular remodeling and MMP-9, TIMP-1 in patients with hypertension diseases

目的：研究缬沙坦改善高血压患者左室重构及其对基质金属蛋白酶-9（ MMP-9）、基质金属蛋白酶抑制剂-1（TIMP-1）的影响，探讨其临床意义。方法对照组采用常规治疗，治疗组在此基础上加用缬沙坦，观察两组治疗前后左室质量指数（ LVMI）、相对室壁厚（ RWT）和血清MMP-9及TIMP-1变化情况。结果高血压患者 LV-MI、RWT和血清MMP-9、TIMP-1及MMP-9/TIMP-1比值较健康组显著升高（ P﹤0.01）；治疗组治疗后 LVMI、RWT和血清MMP-9、TIMP-1及MMP-9/TIMP-1比值较治疗前显著降低，治疗后组间比较，血 LVMI、RWT和血清MMP-9、TIMP-1及MMP-9/TIMP-1比值差异有统计学意义（ P均﹤0.05）；血清 MMP-9、TIMP-1水平与LVMI及RWT水平呈明显正相关。结论 MMP-9、TIMP-1与高血压左室肥厚的发生密切相关，缬沙坦具有逆转高血压心肌纤维化，改善左室重构的作用，其机制可能是通过降低 MMP-9、TIMP-1表达，改善 MMP-9/TIMP-1失衡状态从而抑制左室重构。

Objective To investigate the clinical significance and effects of valsartan on left ventricular remodeling and serum MMP-9 ,TIMP-1 levels in hypertension patients. Methods The patients in control group were treated only by conventional therapy,and the patients in treatment group were given Valsartan and conventional therapy. The changes of LVMI,RWT and serum MMP-9 ,TIMP-1 levels before and after treatment of the two groups were observed. Results In hypertension group the LVMI,RWT and serum MMP-9 ,TIMP-1 ,MMP-9/TIMP-1 levels were higher than those in the healthy control group（ P ﹤ 0. 01 ）. The levels of LVMI,RWT and serum MMP-9 , TIMP-1 ,MMP-9/TIMP-1 after Valsartan treatment were significant lower than those before treatment in the treatment group（ P all﹤0. 01 ）,and the levels of LVMI,RWT were positively correlated with serum MMP-9 ,TIMP-1 ,MMP-9/TIMP-1 levels（ P all﹤0. 05 ）. Conclusions MMP-9 and TIMP-1 are closely related to left ventricular remodeling in patients with hypertension,valsartan can reverse hypertension myocardial fibrosis so as to improve left ventricular remodeling,the mechanism may be through inhibits myocardial remodeling by reducing the expressions of MMP-9 ,TIMP-1 and improve the MMP-9/ TIMP-1 ratio disbalance state.