氨氯地平联合辛伐他汀对高血压患者颈动脉内膜中层厚度的影响

Effect of amlodipine combined with simvastatin on carotid intima-media thickness in patients with hypertension

目的研究氨氯地平联合辛伐他汀对高血压患者颈动脉内膜中层厚度的影响,为高血压患者的临床治疗提供指导。方法选取深圳市大鹏新区妇幼保健院内科于2017年9月至2018年11月收治的60例高血压患者进行研究,按照随机数表法将患者分为观察组和对照组,每组30例。对照组给予氨氯地平治疗,观察组则给予辛伐他汀联合氨氯地平治疗。治疗8周后,观察并比较两组患者的血压[舒张压(DBP)、收缩压(SBP)]、血脂[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、颈动脉内膜中层厚度(IMT)、斑块面积变化以及并发症发生情况。结果治疗后,观察组患者DBP (75.68±2.07) mmHg、SBP (126.34±3.50) mmHg水平较治疗前DBP (96.65±10.92) mm Hg、SBP (169.38±15.50) mmHg水平明显下降,对照组患者DBP (85.34±4.15) mmHg、SBP (136.34±3.05) mmHg水平也较治疗前DBP (95.36±10.27) mmHg、SBP (167.43±16.12) mmHg水平明显下降,且观察组DBP和SBP水平较对照组降低更显著,差异均有统计学意义(P<0.05);观察组患者的血清LDL-C(2.06±0.12) mmol/L、TG (1.05±0.02) mmol/L及TC (4.53±0.03) mmol/L水平较治疗前(3.76±0.50) mmol/L、(1.67±0.76) mmol/L、(5.73±0.78) mmol/L明显下降,HDL-C (1.83±0.04) mmol/L水平则较治疗前(1.23±0.55) mmol/L明显上升,对照组患者的血清LDL-C (3.14±0.07) mmol/L、TG (1.48±0.03) mmol/L及TC (5.18±0.06) mmol/L水平也较治疗前(3.69±0.48) mmol/L、(1.62±0.87) mmol/L、(5.66±0.78) mmol/L明显下降,HDL-C (1.48±0.03) mmol/L水平较治疗前(1.26±0.56) mmol/L明显上升,且观察组患者血清LDL-C、TG、TC及HDL-C改善水平较对照组更为显著,差异均有统计学意义(P<0.05);观察组患者的颈动脉斑块面积(20.15±5.67) mm^2及IMT (0.91±0.08) mm较治疗前的(25.85±9.32) mm^2、(1.13±0.22) mm显著下降,对照组患者颈动脉斑块面积(25.26±10.02) mm^2及IMT (1.06±0.15) mm也较治疗前的(26.43±9.21) mm^2、(1.09±0.13) mm显著下降,且观察组患者颈动脉斑块面积下降水平较对照组更为显著,差异均有统计学意义(P<0.05);两组患者均未发生肌酸激酶、肝酶异常及肌痛等不良反应。结论氨氯地平联合辛伐他汀能显著改善高血压患者血压和血脂水平,降低颈动脉内膜中层厚度而减少颈动脉粥样硬化程度,安全性良好,值得在临床推广应用。

Objective To study the effect of amlodipine combined with simvastatin on carotid intima-media thickness in patients with hypertension. Methods A total of 60 patients with hypertension, who admitted to Department of Internal Medicine of Maternal and Child Health Hospital of Dapeng New District of Shenzhen from September 2017 to November 2018, were enrolled and divided into the study group and control group according to random number table method, with 30 cases in each group. The control group was treated with amlodipine, and the study group was treated with amlodipine in combination with simvastatin. After 8 weeks of treatment, blood pressure (diastolic blood pressure [DBP]), systolic blood pressure [SBP], blood lipids (triglyceride [TG], total cholesterol [TC], low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol)[HDL-C]), carotid intima-media thickness (IMT), plaque area changes, and complications were observed and compared between the two groups. Results After treatment, the DBP and SBP levels in the study group were (75.68±2.07) mmHg and (126.34±3.50) mmHg, respectively, which were significantly lower than corresponding (96.65±10.92) mmHg and (169.38±15.50) mmHg before treatment (P<0.05);the DBP and SBP levels in the control group were (85.34±4.15) mmHg and (136.34±3.05) mmHg, respectively, which were also significantly lower than corresponding (95.36±10.27) mmHg and (167.43±16.12) mmHg of before treatment (P<0.05);the levels of DBP and SBP in the observation group were significantly lower than those in the control group, and the differences were statistically significant (P<0.05);the LDL-C, TG and TC levels in the study group were (2.06±0.12) mmol/L,(1.05±0.02) mmol/L,(4.53± 0.03) mmol/L, respectively, which were significantly lower than corresponding (3.76±0.50) mmol/L,(1.67±0.76) mmol/L,(5.73±0.78) mmol/L before treatment (P<0.05);the level of HDL-C was (1.83±0.04) mmol/L, which was significantly higher than (1.23±0.55) mmol/L before treatment (P<0.05);the levels of LDL-C, TG and TC in the control group were (3.14±0.07) mmol/L,(1.48±0.03) mmol/L,(5.18±0.06) mmol/L, which were also significantly lower than corresponding (3.69±0.48) mmol/L,(1.62±0.87) mmol/L,(5.66±0.78) mmol/L before treatment (P<0.05);HDL-C level increased significantly from (1.26±0.56) mmol/L before treatment to (1.48±0.03) mmol/L (P<0.05);the levels of serum LDL-C, TG, TC and HDL-C in the observation group were significantly higher than those in the control group, and the difference was statistically significant (all P<0.05);Carotid plaque area and IMT in the study group were (20.15±5.67) mm2 and (0.91± 0.08) mm, which were significantly lower than (25.85±9.32) mm2 and (1.13±0.22) mm before treatment (P<0.05), and carotid plaque area and IMT in the control group were (25.26±10.02) mm2 and (1.06±0.15) mm, which were also significantly lower than corresponding (26.43±9.21) mm2 and (1.09±0.13) mm before treatment (P<0.05);the decrease of carotid plaque area in the observation group was more significant than that in the control group, and the difference was statistically significant (P<0.05). There were no adverse reactions such as creatine kinase, liver enzyme abnormality and myalgia in the two groups, and there was also no significant difference between the two groups (P>0.05). Conclusion Amlodipine combined with simvastatin can significantly improve blood pressure and blood lipid levels in patients with hypertension and reduce carotid atherosclerosis by reducing carotid intima-media thickness, and it is safe and worthy of clinical application.