血脂康联合依折麦布对原发性高血压合并血脂异常患者髓过氧化物酶和尿微量白蛋白的影响

Effects of xuezhikang combined with ezetimibe on myeloperoxidase and microalbuminuria in hypertensive patients with dyslipidemia

目的观察血脂康联合依折麦布对原发性高血压合并血脂异常患者的降脂效果及对髓过氧化物酶(MPO)及微量白蛋白尿(MAU)的影响,并探讨其降脂外心血管获益的机制。方法入选血脂异常且未规律服用降脂药物的原发性高血压患者76例,随机分为3组。A组(n=24)血脂康治疗组:血脂康胶囊600 mg 2次/d;B组(n=20)依折麦布治疗组:依折麦布10 mg,1次/d;C组(n=32)血脂康联合依折麦布治疗组:血脂康600mg,2次/d+依折麦布10 mg 1次/d。常规检测血脂、肝生化、心肌酶谱、肾功、电解质、空腹血糖、同型半胱氨酸(Hcy),检测血MPO、尿微量白蛋白/肌酐(ACR)。治疗2个月后再次复查上述指标,比较各组用药前后各项指标的差异。结果 A组治疗后三酰甘油、总胆固醇、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)显著下降,差异有统计学意义(P<0.05),MPO水平较治疗前下降,差异有统计学意义(P<0.05),而ACR水平无明显改变;B组治疗后三酰甘油、总胆固醇、LDL-C有下降,差异有统计学意义(P<0.05),MPO及ACR水平无明显改变;C组治疗后三酰甘油、总胆固醇、LDL-C显著下降,差异有统计学意义(P<0.05)。MPO水平及ACR水平较治疗前明显下降,差异均有统计学意义(P<0.05);3组治疗前后肝、肾功能及肌酸激酶无明显差异。3组中均未出现严重不良反应。结论血脂康联合依折麦布的降低LDL-C的作用明显优于单用血脂康或依折麦布,显著降低MPO及ACR,改善氧化应激状态和血管内皮功能,对预防高血压合并血脂异常的患者发生心血管事件可能有着良好的干预作用。

Objective To investigate the lipid-lowering effect of Xuezhikang combined with ezetimibe on patients with primary hypertension and dyslipidemia and their influences on myeloperoxidase（ MPO） and microalbuminuria（ MAU）,and to explore the mechanism of cardiovascular benefits beyond lipid-lowering so as to provide theoretical basis for preventing cardiovascular events in patients with hypertension and dyslipidemia. Methods A total of 76 hypertensive patients with dyslipidemia,who did not regularly take lipid-lowering drugs,were randomly divided into 3 groups. Patients in group A（ n = 24） received 600 mg of Xuezhikang capsule orally twice daily; patients in group B（ n = 20） received 10 mg of ezetimibe orally once daily; and patients in group C（ n = 32） received 600 mg of Xuezhikang capsule orally twice daily ＋ 10 mg of ezetimibe orally once daily. Routine blood tests including cholesterol,liver biochemistry,myocardial enzymes,renal function,blood electrolytes,fasting blood glucose（ FBG）,homocysteine（ Hcy）,blood MPO,urinary microalbumin/creatinine（ ACR） were measured at the time of treatment and 2 months after treatment.Results The levels of triglyceride（ TG）,total cholesterol（ TC） and low density lipoprotein cholesterol（ LDL-C）were significantly decreased in group A,and the level of MPO was significantly lower after treatment（ P〈0. 05）,but ACR level had no significant change. The levels of TG,TC and LDL-C in group B were decreased after treatment,the level of MPO and ACR had no significant changes（ P〉0. 05）. The levels of TG,TC and LDL-C in group C were significantly decreased after treatment. Both MPO and ARC levels also significantly decreased after treatment. There were no significant differences in liver,renal function and creatine kinase before and after treatment in either groups（ P〈0. 05）. No serious adverse reactions were observed in the three groups. Conclusion A combination of Xuezhikang and Ezetimibe has more LDL-C lowering effect than either Ezetimibe or Xuezhikang alone. Xuezhikang combined with Ezetimibe can also decrease the level of MPO and ACR significantly,which means it can ameliorate oxidative stress and improve vascular endothelial function in hypertensive patients with dyslipidemia. These may benefit for preventing cardiovascular events in hypertensive patients with dyslipidemia.