氨氯地平对原发性高血压患者心肾的作用及其与细胞内钙关系的初步探讨

Relationship Between Intracellular Free Calcium Concentration and the Effect of Amlodipine Therapy on Heart and Renal Functions in Essential Hypertensive Patients

目的 :探讨氨氯地平对原发性高血压 (EH)患者心肾的作用及其与细胞内胞浆游离钙 ([Ca2 + ] i)的关系。 方法 :选择EH患者 90例 ,予氨氯地平治疗 6个月 ,治疗前后自身对照检测淋巴细胞内 [Ca2 + ] i,2 4小时动态血压 ,左心室重量指数 (LVMI) ,左心室舒张功能和肾功能指标等的变化。 结果 :经氨氯地平治疗后 ,日间、夜间和 2 4小时收缩压和舒张压均显著下降 (P <0 0 1) ,降压谷 /峰值 :收缩压为 79% ,舒张压为 66%。氨氯地平治疗后 [Ca2 + ] i,LVMI和 2 4小时尿蛋白均显著下降 (P <0 0 1) ,左心室后壁厚度及舒张期室间隔厚度均显著下降 ,有显著性差异 (P <0 0 5 )。 [Ca2 + ] i的下降幅度与LVMI的下降幅度呈正相关 (γ =0 6675 ,P <0 0 5 ) ,[Ca2 + ] i的下降幅度与舒张早期血流峰值速度 /舒张晚期血流峰值速度 (E/A)值的上升幅度呈负相关(γ =-0 5 2 3 0 ,P <0 0 5 )。 结论 :氨氯地平治疗EH可达到平稳降压、逆转左心室重构和肾功能损害的疗效 ,[Ca2 + ] i的降低可能参与其改善心肾功能作用。

Objective:To investigate the relationship between intracellular free calcium concentration and the effect of amlodipine therapy on heart and renal functions in essential hypertensive patients. Methods:Ninety essential hypertensive patients were treated with amlodipine for six months,intralymphocytic free calcium concentration([Ca 2+ ] i),ambulatory blood pressure monitoring(ABPM),left ventricular mass index(LVMI),left ventricular function and the parameters of renal function were evaluated before and after trearment. Results:After 6 months of treatment,24 hours micro albuminuria was significantly decreased in sererity(p<0.01).The calculated T/P ratios were 79%(SBP) and 66%(DBP).After treatment,[Ca 2+ ] i,ABPM,LVMI were significantly decreased(p<0.01).Left ventricular function was significantly improved(p<0.05).The changes of [Ca 2+ ] i were correlated positively with LVMI(γ=0.6675,p<0.05),but negatively with E/A ratio (γ=-0.5230,p<0.05). Conclusion:The mechanisms of antihypertensive effect and improvement of heart and renal function by amlodipine therapy may be associated with the normalization of intracellular calcium metabolism.