H型高血压颈动脉粥样硬化机制及依那普利叶酸片干预效果研究

Study on H-type hypertension combined with carotid atherosclerosis and the intervention effect of Enalapril maleate and folic acid tablets

目的 了解H型高血压患者同型半胱氨酸（Hcy）水平与颈动脉粥样硬化、血管炎症的相关性,探讨依那普利叶酸片对动脉粥样硬化的干预效果及其机制.方法 2012年8月至2013年8月从南京鼓楼医院集团仪征医院门诊400例高血压患者中依据纳入标准抽取120例患者,随机分为对照组与治疗组各60例.测定患者Hcy、颈动脉粥样斑块及颈总动脉平均内膜中层厚度（IMT）,计算斑块crouse积分.对照组常规给予依那普利片10 mg/d降压,治疗组选用依那普利叶酸片10 mg·0.8 mg-1·d-1.其他治疗包括常规使用抗血小板、稳定斑块等对症处理,两组基本一致.治疗随访1年后复测上述实验室及器械检查指标.结果 Hcy水平与颈动脉粥样硬化及血管炎症反应指标呈正相关,Hcy越高,IMT值越大;Hcy与IMT的相关系数是0.802.依那普利叶酸片对H型高血压患者的干预效果更佳.治疗前后两组Hcy比较,治疗组治疗前Hcy为（18.15±1.83）μmol/L,治疗后为（10.48± 1.52） μmol/L,差异有统计学意义（P＜0.05）;而对照组变化不显著.结论 Hcy水平是导致颈动脉粥样硬化的重要因素.依那普利叶酸片与依那普利比较,在降压、降低Hcy水平的同时,对颈动脉粥样硬化的进展能起到明显的抑制作用.

Objective To investigate the correlation of Hey level in H-type hypertension patients with carotid atherosclerosis and vascular inflammation, and to explore the intervention effect of Enalapril malcate and folio acid tablets on atherosclerosis and its mechanisms. Methods From August 2012 to August 2013, according to inclusion criteria, 120 patients were selected from 400 hypertensive patients came from Yizheng Hospital, Drum Tower Hospital Group of Nanjing, and randomly divided into control group and treatment group, with 60 patients in each group. Hey, carotid atherosclerotic plaque and common carotid artery intima-media thickness （IMT） were measm＇ed, and Crouse score of plaque was calculated. The control group was routinely treated with Enalapril maleate tablets（ 10 mg/d） for anti-hypertension while the treatment group received Enalapril maleate and folic acid tablets （10 mg·0.8 mg-1·d-1）; other treatments included routine antiplatelet application, plaque stabilization and other symptomatic treatments, which were basically consistent between the two groups. One year after treatment and follow-up, laboratory and equipment indexes mentioned above were retested. Results Hcy level was positively correlated with the indexes of carotid atheroselerosis and vascular inflammation response. The correlation coefficient of Hcy and IMT was 0.802. The intervention effect of Enalapril maleate and folic acid tablets on H-type hyperten- sion patients was superior. Compare two groups before and after treatment of Hcy, the Hcy level in treatment group before treatment was （18.15±1.83）μmol/L, and （10.48±1.52）μmol/L after treatment, the difference was statistically significant （P〈0.05）. While the control group no significant change. Conclusion Hcy level is an important factor leading to carotid atherosclerosis, compared with Enalapril maleate tablets, Enalapril maleate and folic acid tablets have an evidently inhibitory effect on the progression of carotid atherosclerosis in addition to anti-hypertension and reducing Hcy level.