依那普利联合叶酸治疗老年H型高血压病对患者炎性因子及血管内皮功能的影响
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摘要
目的观察依那普利联合叶酸治疗老年H型高血压病对患者炎性因子及血管内皮功能的影响。方法选取老年H型高血压病120例,采用随机数字表法随机将其分为观察组和对照组两组各60例,观察组采用依那普利联合叶酸治疗,对照组采用依那普利治疗,两组均治疗12周。观察比较两组治疗前及治疗12周后收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)及血清同型半胱氨酸(homotypic cysteine,Hcy)、炎性因子、血管内皮功能指标水平。结果治疗前,两组SBP、DBP及血清Hcy、肿瘤坏死因子α(tumor necrosis factor,TNF-α)、超敏C反应蛋白(hypersensitive c reactive protein,hs-CRP)、内皮素1(endothelin,ET-1)、一氧化氮(nitric oxide,NO)水平比较差异无统计学意义(P> 0. 05)。治疗12周后,两组SBP、DBP及血清Hcy、TNF-α、hs-CRP、ET-1水平均显著低于治疗前,血清NO水平显著高于治疗前,差异有统计学意义(P <0. 05)。治疗12周后,观察组SBP、DBP及血清Hcy、TNF-α、hs-CRP、ET-1水平均显著低于对照组,血清NO水平显著高于对照组,差异有统计学意义(P <0. 05)。结论依那普利联合叶酸治疗老年H型高血压病可降低患者血压及血清Hcy水平,抑制炎性因子释放,改善血管内皮功能。
Objective To investigate the effect of Enalapril combined with Folic Acid Tablets on inflammatory factors and vascular endothelial function in elderly patients with H-type hypertension. Methods A total of 120 cases of elderly patients with H-type hypertension were randomly divided into control group( n = 60) and observation group( n = 60),according to random number table. The patients in the control group were treated with Enalapril Maleate Tablets,and those in the observation group were treated with Folic Acid Tablets combined with Enalapril Maleate Tablets. The course of treatment was 12 weeks. The systolic blood pressure( SBP),diastolic blood pressure( DBP) and serum homocytosine( Hcy),inflammatory factors and endothelial function index levels were compared before treatment and 12 weeks after treatment. Results There was no significant difference in the levels of SBP,DBP,Hcy,tumor necrosis factor( TNF-α),hypersensitive c reactive protein( hs-CRP),endothelin( ET-1) and nitric oxide( NO) in the two groups before treatment( P > 0. 05). At 12 weeks after treatment,the levels of SBP,DBP,Hcy,TNF-α,hs-CRP and ET-1 in both groups were significantly lower than those before treatment,whereas the serum NO level was significantly higher than that before treatment( P < 0. 05). At 12 weeks after treatment,the levels of SBP,DBP,Hcy,TNF-α,hs-CRP and ET-1 in the observation group were significantly lower than those in the control group,while the serum NO level was significantly higher than that in the control group( P < 0. 05). Conclusion In the treatment of the elderly with H-type hypertension,folic Acid Tablets combined with Enalapril can effectively reduce the blood pressure and Hcy level,inhibit the release of inflammatory factors and improve vascular endothelial function.
Objective To investigate the effect of Enalapril combined with Folic Acid Tablets on inflammatory factors and vascular endothelial function in elderly patients with H-type hypertension. Methods A total of 120 cases of elderly patients with H-type hypertension were randomly divided into control group( n = 60) and observation group( n = 60),according to random number table. The patients in the control group were treated with Enalapril Maleate Tablets,and those in the observation group were treated with Folic Acid Tablets combined with Enalapril Maleate Tablets. The course of treatment was 12 weeks. The systolic blood pressure( SBP),diastolic blood pressure( DBP) and serum homocytosine( Hcy),inflammatory factors and endothelial function index levels were compared before treatment and 12 weeks after treatment. Results There was no significant difference in the levels of SBP,DBP,Hcy,tumor necrosis factor( TNF-α),hypersensitive c reactive protein( hs-CRP),endothelin( ET-1) and nitric oxide( NO) in the two groups before treatment( P > 0. 05). At 12 weeks after treatment,the levels of SBP,DBP,Hcy,TNF-α,hs-CRP and ET-1 in both groups were significantly lower than those before treatment,whereas the serum NO level was significantly higher than that before treatment( P < 0. 05). At 12 weeks after treatment,the levels of SBP,DBP,Hcy,TNF-α,hs-CRP and ET-1 in the observation group were significantly lower than those in the control group,while the serum NO level was significantly higher than that in the control group( P < 0. 05). Conclusion In the treatment of the elderly with H-type hypertension,folic Acid Tablets combined with Enalapril can effectively reduce the blood pressure and Hcy level,inhibit the release of inflammatory factors and improve vascular endothelial function.
引文
[1]李华平,洪梅,赵文雪,等.老年高血压病人同型半胱氨酸与尿微量白蛋白的相关性[J].实用老年医学,2017,31(12):1154-1156.
[2]顾明霞,王春宁,张英强,等.叶酸和维生素B6/B12联合使用对老年H型高血压病人心功能的影响[J].实用老年医学,2017,31(10):934-937.
[3] Qin X,Shen L,Zhang R,et al. Effect of folic acid supplementation on cancer risk among adults with hypertension in China:Arandomized clinical trial[J].Int J Cancer,2016,141(4):837-847.
[4] Ostojic P,Stojanovski N. Arterial hypertension treated with angiotensin converting enzyme inhibitors and glucocorticoids are independent risk factors associated with decreased glomerular filtration rate in systemic sclerosis[J]. Rheumatol Int,2017,37(3):363-368.
[5]周玉婕.血管紧张素转换酶抑制剂治疗高血压疗效观察[J].深圳中西医结合杂志,2015,25(20):131-132.
[6]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压病杂志,2011,39(7):579-616.
[7]陈敏.依那普利叶酸片治疗H型高血压疗效及其作用机制分析[J].临床合理用药杂志,2017,10(13):69-70.
[8]杨峰,郭民旺,周汝娟,等.甲钴胺对H型高血压患者血浆炎性因子及颈动脉斑块的影响[J].中国综合临床,2015,31(1):30-32.
[9]胡咏梅,付秋玉. H型高血压临床分析[J].临床荟萃,2014,29(8):908-909.
[10]杨凯,江成功,顾建明,等.强化降脂方案对老年原发性高血压患者血脂、炎性细胞因子及动脉弹性参数指标水平的影响[J].湖南师范大学学报(医学版),2017,14(5):120-123.
[11]邹青,赵连友,李雪,等.依那普利叶酸片改善H型高血压左室肥厚患者的心功能[J].中国循证心血管医学杂志,2015,7(2):188-191.
[12]张雅莉,李玉华,谢玉平,等.营养干预对H型高血压治疗的作用[J].中国临床医生杂志,2016,44(8):47-50.
[13]张立红.依那普利联合叶酸片治疗H型高血压疗效及作用机制探讨[J].海南医学院学报,2016,22(2):147-150.
[14] Kim N H. Group 4 pulmonary hypertension:chronic thromboembolic pulmonary hypertension:epidemiology,pathophysiology, and treatment[J]. Cardiol Clin,2016,34(3):435-441.
[15]李理,汤哲.老年H型高血压的流行病学研究进展[J].中华流行病学杂志,2014,35(9):1075-1077.
[16]《中国高血压防治指南》修订委员会.中国高血压防治指南:2010年修订版[M].北京:人民卫生出版社,2012.
[17] Qin X,Huo Y. H-Type hypertension,stroke and diabetes in China:Opportunities for primary prevention[J]. J Diabetes,2016,8(1):38-40.
[18] Towfighi A,Markovic D,Ovbiagele B. Pronounced association of elevated serum homocysteine with stroke in subgroups of individuals:A nationwide study[J]. J Neurol Sci,2010,298(1-2):153-157.
[19] Li L,Tang Z. Epidemiological studies of H-type hypertension in the elderly[J]. Zhonghua Liu Xing Bing Xue Za Zhi,2014,35(9):1075-1077.
[20] Ma L,Li L,Tang Z. Epidemiological characteristics of hyperhomocysteinemia and H-type hypertension in the elderly in Beijing,China[J]. Clin Exp Hypertens,2017,34(6):1-5.
[21]李庆辉,杨天伦,谭碧峰,等. H型高血压患者内皮脂肪酶和脂联素水平变化[J].中国循证心血管医学杂志,2016,8(3):302-304.
[22]秦景梅,商秀芳,丛晓荣.叶酸辅助治疗对H型高血压患者血清同型半胱氨酸和血压负荷及血压变异性的影响[J].中国医药,2015,10(12):1753-1757.
[23]吴金花,张海丽,付梅. H型高血压患者血管内皮损伤与炎症反应的相关性研究[J].武警后勤学院学报(医学版),2015,24(8):631-633.
[24]刘时武,王喜玉,马建林,等. H型高血压患者脂质过氧化损伤和血管内皮功能变化分析[J].中国医药,2015,10(9):1257-1259.
[25]王慧,李嘉民,赵素霞,等. H型高血压与脑梗死后早期康复效果的相关性[J].临床荟萃,2015,30(5):503-505.
[26]王洋,王希柱,王彦,等. H型高血压患者血同型半胱氨酸水平与颈动脉粥样硬化的临床分析[J].中国煤炭工业医学杂志,2015,18(3):398-401.
[27]赵明枝.叶酸对同型半胱氨酸升高型高血压的疗效观察[J].中国实用神经疾病杂志,2012,15(7):63-64.
[28] Qin X,Li J,Spence J D,et al. Folic acid therapy reduces the first stroke risk associated with hypercholesterolemia among hypertensive patients[J].Stroke,2016,47(11):2805-2812.
[29]张艺洁.叶酸联合血管紧张素转化酶抑制剂对H型高血压患者血管紧张素转化酶活性的影响及相关因素分析[D].昆明:昆明医科大学,2017.
[30]朱泓霞,王雪锋,徐倩.硝苯地平缓释片分别联用马来酸依那普利片与酒石酸美托洛尔片治疗高危高血压的临床疗效观察[J].中国临床药理学与治疗学,2014,19(10):1167-1170.
[31]辛成慧.依那普利与卡托普利对原发性高血压患者降压的临床疗效比较[J].抗感染药学,2016,13(6):1409-1411.
[32]唐强,黄友良,俞群军,等.血管紧张素转化酶基因多态性与依那普利降压疗效的相关性研究[J].中国临床药理学与治疗学,2009,14(1):72-75.
[33]吕纯芳,张涛,李丽琳.叶酸干预前后H型高血压同型半胱氨酸与尿酸的相关性分析[J].公共卫生与预防医学,2015,26(1):46-48.
[34]耿慧,张静,刘永东.福辛普利联合叶酸片治疗老年H型高血压的疗效观察[J].医学与哲学(B),2017,38(10):28-29,45.
[35]张立红.依那普利联合叶酸片治疗H型高血压疗效及作用机制探讨[J].海南医学院学报,2016,22(2):147-150.
[36]王春. H型高血压患者炎症水平与内皮功能的关系研究[D].南昌:南昌大学医学院,2015.
[37]张勇. H型高血压患者血管内皮功能变化及与血浆同型半胱氨酸水平的关系[J].河北医药,2017,39(17):2593-2596.
[38] Chalupsky K,Kracun D,Kanchev I,et al. Folic acid promotes recycling of tetrahydrobiopterin and protects against hypoxia-induced pulmonary hypertension by recoupling endothelial nitric oxide synthase[J]. Antioxid Redox Signal,2015,23(14):1076-1091.
[39]袁坚宾.原发性高血压患者血清同型半胱氨酸含量与颈动脉粥样硬化、左心室舒张功能的相关性[J].海南医学院学报,2016,22(23):2804-2807.
[2]顾明霞,王春宁,张英强,等.叶酸和维生素B6/B12联合使用对老年H型高血压病人心功能的影响[J].实用老年医学,2017,31(10):934-937.
[3] Qin X,Shen L,Zhang R,et al. Effect of folic acid supplementation on cancer risk among adults with hypertension in China:Arandomized clinical trial[J].Int J Cancer,2016,141(4):837-847.
[4] Ostojic P,Stojanovski N. Arterial hypertension treated with angiotensin converting enzyme inhibitors and glucocorticoids are independent risk factors associated with decreased glomerular filtration rate in systemic sclerosis[J]. Rheumatol Int,2017,37(3):363-368.
[5]周玉婕.血管紧张素转换酶抑制剂治疗高血压疗效观察[J].深圳中西医结合杂志,2015,25(20):131-132.
[6]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压病杂志,2011,39(7):579-616.
[7]陈敏.依那普利叶酸片治疗H型高血压疗效及其作用机制分析[J].临床合理用药杂志,2017,10(13):69-70.
[8]杨峰,郭民旺,周汝娟,等.甲钴胺对H型高血压患者血浆炎性因子及颈动脉斑块的影响[J].中国综合临床,2015,31(1):30-32.
[9]胡咏梅,付秋玉. H型高血压临床分析[J].临床荟萃,2014,29(8):908-909.
[10]杨凯,江成功,顾建明,等.强化降脂方案对老年原发性高血压患者血脂、炎性细胞因子及动脉弹性参数指标水平的影响[J].湖南师范大学学报(医学版),2017,14(5):120-123.
[11]邹青,赵连友,李雪,等.依那普利叶酸片改善H型高血压左室肥厚患者的心功能[J].中国循证心血管医学杂志,2015,7(2):188-191.
[12]张雅莉,李玉华,谢玉平,等.营养干预对H型高血压治疗的作用[J].中国临床医生杂志,2016,44(8):47-50.
[13]张立红.依那普利联合叶酸片治疗H型高血压疗效及作用机制探讨[J].海南医学院学报,2016,22(2):147-150.
[14] Kim N H. Group 4 pulmonary hypertension:chronic thromboembolic pulmonary hypertension:epidemiology,pathophysiology, and treatment[J]. Cardiol Clin,2016,34(3):435-441.
[15]李理,汤哲.老年H型高血压的流行病学研究进展[J].中华流行病学杂志,2014,35(9):1075-1077.
[16]《中国高血压防治指南》修订委员会.中国高血压防治指南:2010年修订版[M].北京:人民卫生出版社,2012.
[17] Qin X,Huo Y. H-Type hypertension,stroke and diabetes in China:Opportunities for primary prevention[J]. J Diabetes,2016,8(1):38-40.
[18] Towfighi A,Markovic D,Ovbiagele B. Pronounced association of elevated serum homocysteine with stroke in subgroups of individuals:A nationwide study[J]. J Neurol Sci,2010,298(1-2):153-157.
[19] Li L,Tang Z. Epidemiological studies of H-type hypertension in the elderly[J]. Zhonghua Liu Xing Bing Xue Za Zhi,2014,35(9):1075-1077.
[20] Ma L,Li L,Tang Z. Epidemiological characteristics of hyperhomocysteinemia and H-type hypertension in the elderly in Beijing,China[J]. Clin Exp Hypertens,2017,34(6):1-5.
[21]李庆辉,杨天伦,谭碧峰,等. H型高血压患者内皮脂肪酶和脂联素水平变化[J].中国循证心血管医学杂志,2016,8(3):302-304.
[22]秦景梅,商秀芳,丛晓荣.叶酸辅助治疗对H型高血压患者血清同型半胱氨酸和血压负荷及血压变异性的影响[J].中国医药,2015,10(12):1753-1757.
[23]吴金花,张海丽,付梅. H型高血压患者血管内皮损伤与炎症反应的相关性研究[J].武警后勤学院学报(医学版),2015,24(8):631-633.
[24]刘时武,王喜玉,马建林,等. H型高血压患者脂质过氧化损伤和血管内皮功能变化分析[J].中国医药,2015,10(9):1257-1259.
[25]王慧,李嘉民,赵素霞,等. H型高血压与脑梗死后早期康复效果的相关性[J].临床荟萃,2015,30(5):503-505.
[26]王洋,王希柱,王彦,等. H型高血压患者血同型半胱氨酸水平与颈动脉粥样硬化的临床分析[J].中国煤炭工业医学杂志,2015,18(3):398-401.
[27]赵明枝.叶酸对同型半胱氨酸升高型高血压的疗效观察[J].中国实用神经疾病杂志,2012,15(7):63-64.
[28] Qin X,Li J,Spence J D,et al. Folic acid therapy reduces the first stroke risk associated with hypercholesterolemia among hypertensive patients[J].Stroke,2016,47(11):2805-2812.
[29]张艺洁.叶酸联合血管紧张素转化酶抑制剂对H型高血压患者血管紧张素转化酶活性的影响及相关因素分析[D].昆明:昆明医科大学,2017.
[30]朱泓霞,王雪锋,徐倩.硝苯地平缓释片分别联用马来酸依那普利片与酒石酸美托洛尔片治疗高危高血压的临床疗效观察[J].中国临床药理学与治疗学,2014,19(10):1167-1170.
[31]辛成慧.依那普利与卡托普利对原发性高血压患者降压的临床疗效比较[J].抗感染药学,2016,13(6):1409-1411.
[32]唐强,黄友良,俞群军,等.血管紧张素转化酶基因多态性与依那普利降压疗效的相关性研究[J].中国临床药理学与治疗学,2009,14(1):72-75.
[33]吕纯芳,张涛,李丽琳.叶酸干预前后H型高血压同型半胱氨酸与尿酸的相关性分析[J].公共卫生与预防医学,2015,26(1):46-48.
[34]耿慧,张静,刘永东.福辛普利联合叶酸片治疗老年H型高血压的疗效观察[J].医学与哲学(B),2017,38(10):28-29,45.
[35]张立红.依那普利联合叶酸片治疗H型高血压疗效及作用机制探讨[J].海南医学院学报,2016,22(2):147-150.
[36]王春. H型高血压患者炎症水平与内皮功能的关系研究[D].南昌:南昌大学医学院,2015.
[37]张勇. H型高血压患者血管内皮功能变化及与血浆同型半胱氨酸水平的关系[J].河北医药,2017,39(17):2593-2596.
[38] Chalupsky K,Kracun D,Kanchev I,et al. Folic acid promotes recycling of tetrahydrobiopterin and protects against hypoxia-induced pulmonary hypertension by recoupling endothelial nitric oxide synthase[J]. Antioxid Redox Signal,2015,23(14):1076-1091.
[39]袁坚宾.原发性高血压患者血清同型半胱氨酸含量与颈动脉粥样硬化、左心室舒张功能的相关性[J].海南医学院学报,2016,22(23):2804-2807.