盐敏感性高血压病患者血浆TXB_2、6-k-PGF_（1α）浓度的变化以及不同类型高血压和血脂异常在老年急性心肌梗死患者中的分布
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摘要
目的 盐敏感性(SS)高血压病较非盐敏感性(NSS)高血压病容易出现靶器官损害，发生心、脑血管并发症的危险性更大，其机制尚未阐明。不同的危险因素对老年人及年轻人急性心肌梗死(AMI)的影响不同。有关老年AMI与不同类型高血压的关系以及老年AMI患者血脂异常的分布与他汀类药物早期应用情况的报道较少。本研究旨在探讨血栓素B_2(TXB_2)、6-酮-前列腺素F_(1α)(6-k-PGF_(1α))在盐敏感性高血压病心、脑血管并发症发病中的作用以及老年AMI患者不同类型高血压和血脂异常的分布与他汀类药物早期应用的情况。
方法 1．采用改良的Sullivan急性口服盐水负荷试验的方法将60例高血压病患者分为SS(28例)和NSS(32例)两组。30例正常人为对照组。采用放射免疫法测定其血浆TXB_2和6-k-PGF_(1α)水平。2．观察189例老年AMI患者不同年龄组间不同类型高血压和血脂异常的分布与他汀类药物早期应用的情况。
结果 1．SS高血压病组血浆TXB_2水平[(48.76±21.34)pg／ml]显著高于NSS高血压病组[(31.67±5.30)pg／ml]或正常组[(30.01±
Objectives Salt-sensitive (SS) essential hypertensive patients are more likely to develop end-organ damage such as cardiovascular or cerebrovascular complications than the non-salt-sensitive (NSS), yet the mechanism is not well understood. The relationship of various risk factors for coronary heart disease (CHD) with acute myocardial infarction (AMI) in the young or elderly is different. There were only very few reports about the significance of different types of hypertension, the distribution of blood lipids disorders and the status of early statins use in elderly patients with AMI. The purpose of this study was to evaluate the possible roles of thromboxane B_2 (TXB_2) and 6-ketone-prostaglandinF_(1α) (6-k-PGF_(1α)) in the increased incidence of cardiovascular or cerebrovascular complications in SS essential hypertensive patients. Furthermore, the distribution of different types of hypertension and blood lipids disorders and the status of early statins use in elderly patients with AMI were also investigated.
方法 1．采用改良的Sullivan急性口服盐水负荷试验的方法将60例高血压病患者分为SS(28例)和NSS(32例)两组。30例正常人为对照组。采用放射免疫法测定其血浆TXB_2和6-k-PGF_(1α)水平。2．观察189例老年AMI患者不同年龄组间不同类型高血压和血脂异常的分布与他汀类药物早期应用的情况。
结果 1．SS高血压病组血浆TXB_2水平[(48.76±21.34)pg／ml]显著高于NSS高血压病组[(31.67±5.30)pg／ml]或正常组[(30.01±
Objectives Salt-sensitive (SS) essential hypertensive patients are more likely to develop end-organ damage such as cardiovascular or cerebrovascular complications than the non-salt-sensitive (NSS), yet the mechanism is not well understood. The relationship of various risk factors for coronary heart disease (CHD) with acute myocardial infarction (AMI) in the young or elderly is different. There were only very few reports about the significance of different types of hypertension, the distribution of blood lipids disorders and the status of early statins use in elderly patients with AMI. The purpose of this study was to evaluate the possible roles of thromboxane B_2 (TXB_2) and 6-ketone-prostaglandinF_(1α) (6-k-PGF_(1α)) in the increased incidence of cardiovascular or cerebrovascular complications in SS essential hypertensive patients. Furthermore, the distribution of different types of hypertension and blood lipids disorders and the status of early statins use in elderly patients with AMI were also investigated.
引文
1. Sullivan JM. Salt sensitivity: definition, conception, methodology and long-term issues. Hypertension, 1991, 17(Suppl I): I-61
2. Campese VM. Salt sensitivity in hypertension: renal and cardiovascular implications. Hypertension, 1994, 23: 531-550
3. Weinberger MH. Salt sensitivity of blood pressure in humans. Hypertension, 1996, 27(3): 481
4．刘治全．盐敏感性高血压．见：刘力生，龚兰生，陈孟勤等主编．高血压．第1版．北京：人民卫生出版社，2001，512-526
5．刘敏涓，刘泽霖．血栓性疾病的发病机制与危险因素．见：刘泽霖，贺石林，李家增主编．血栓性疾病的诊断与治疗．第1版．北京：人民卫生出版社，2000，8-11
6. Somova L, Mackraj L, Chetty S. Sympathetic and platelet adrenergic activity and salt sensitivity: an experimental study. Methods Find Exp Clin Pharmacol, 1998, 20(8): 657-665
7. Somova L, Mufunda J. Platelet activity and salt sensitivity in the pathogenesis of systemic (essential) hypertension in black Africans. Clin Exp Hypertens, 1993, 15(5): 781-796
8．李玉明，刘治全，杨鼎颐．盐敏感者在高血压人群中的分布及盐敏感性标志的筛选研究．中华心血管病杂志，1994，22：89
9. Bornbeli T, Michele M, Maeberli A. Anticoagulant properties of the vascular endothelium. Thromb Haemost, 1997, 77: 408
10. Ruggeri ZM. Mechanisms initiating platelet thrombus formation. Thromb Haemost, 1997, 78(1): 611
11．刘汉，景本年，李卓江．血栓前状态分子标志物研究进展．国外医学临床生物化学与检验学分册，2000，21(5)：239-240
12. Lip GYH. Target organ damage and the prothrombotic state in hypertension. Hypertension, 2000, 36(6): 975-977
13．欧阳迎春，刘应才，余琴等．原发性高血压血栓前状态标志物变化及其意义．临床心血管病杂志，2002，18(6)：248-250
14. Fuenmayor N, Moreira E, Cubeddu LX. Salt sensitivity is associated with insulin resistance in essential hypertension. Am J Hypertens, 1998, 11(4 Pt 1): 397-402
15. John SW, Krege JH, Oliver PM, et al. Genetic decreases in atrial natfiuretic peptide and salt-sensitive hypertension. Science, 1995, 267: 679-681
1. Barakat K, Wilkinson P, Deaner A, et al. How should age affect management of acute myocardial infarction ? A prospective cohort study. Lancet, 1999, 353(9157): 955-959
2. DeGeare VS, Stone GW, Grines L, et al. Angiographic and clinical characteristics associated with increased inhospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the Primary Angioplasty in Myocardial Infarction Trials). Am J Cardiol, 2000, 86: 30-34
3. Collinson J, Flather MD, Fox KAA, et al. Clinical outcomes, risk stratification and practice patterns of unstable angina and myocardial infarction without ST segment elevation: prospective registry of acute ischaemic syndromes in the UK (PRAIS-UK). Eur Heart J, 2001, 21: 1450-1457
4. Williams D, Kim KS, Adams-Campbell LL. Survival benefit from calcium channel blockers in elderly blacks following acute myocardial infarction. Ethn Dis, 2002, 12(2): 229-233
5. Jousilahti P, Vartiainen E, Tuomilehto J, et al. Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation, 1999, 99: 1165-1172
6. Capewell S, Morrison CE, McMurray JJ. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and1994. Heart, 1999, 81: 380-386
7．刘晓宁，张春玲，武文君等．年轻人冠心病危险因素分布及聚集状况．中华心血管病杂志，2003，31(2)：87-90
8．王晋军，杨超慧，张颖等．老年冠心病患者冠状动脉病变特点及其危险因素的多元回归分析．中华老年医学杂志，2002，21(3)：172-174
9. Selwyn AP, Kinlay S, Libby P, et al. Atherogenic lipids, vascular dysfunction, and clinical signs of ischemic heart disease. Circulation, 1997, 95(1): 5-7
10. De Meyer GRY, Herman AG. Vascular endothelial dysfunction. Prog Cardiovasc Dis, 1997, 39(4): 325-342
11．党爱民，刘国仗．高血压与心脏．见：刘力生，龚兰生，陈孟勤等主编．高血压．第1版．北京：人民卫生出版社，2001，870-873
12. Franklin SS, Khan SA, Wong ND, et al. Is pulse pressure useful in predicting coronary heart disease ? The Framingham Heart Study. Circulation, 1999, 100: 354-360
13. Amery A, Birkenhager W, Bulpitt CJ, et al. Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: objectives, protocol, and organization. Aging Clin Exp Res, 1991.3: 287-302
14．中国老年收缩期高血压临床试验协作组．中国老年收缩期高血压临床试验总结报告．中华心血管病杂志，1998，26(5)：329-333
15．张宇清，刘国仗．老年收缩期高血压．见：刘力生，龚兰生，陈孟勤等主编．高血压．第1版．北京：人民卫生出版社，2001，495-496
1．徐成斌．论急性冠状动脉综合征他汀类药物早期应用的益处．中华心血管病杂志，2001，29(3)：129-131
2. David D, Waters MD. Early pharmacologic intervention and plaque stability in acute coronary syndromes. Am J Cardiol, 2001, 88(Suppl): 30k-36k
3. The Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4 444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet, 1994, 344: 1383-1389
4. Mannien V, Tenkanen L, Koskinen P. et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study: implications for treatment. Circulation, 1992, 70: 733-737
5. Ericsson CG, Hamsten A, Nilsson J, et al. An angiographic assessment of effects of bezafibrate on progression of coronary artery disease in young male postinfarction patients. Lancet, 1996, 347: 849-853
6. Yoshimura A, Saikawa T, Takakura T, et al. Serum lipid states in elderly patients with acute myocardial infarction: comparison between patients aged 60 to 79 and 80 years and over. J Cardiol, 1995, 25(3): 113-118
7．中华心血管病杂志编辑委员会血脂异常防治对策专题组．血脂异常防治建议．中华心血管病杂志，1997，25(3)：169-175
8．赵水平，张湘瑜，高梅等．小剂量辛伐他汀对急性心肌梗死患者血管内皮功能的影响．中华心血管病杂志，2001，29(3)：136-139
9. Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA, 2001, 285: 1711-1718
10. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA). Early statin treatment following acute myocardial infarction and 1-year survival. JAMA, 2001, 285: 430-436
11．李毅夫，赵水平．胰岛素抵抗综合征．见：赵水平，王钟林，陆宗良主编．临床血脂学．第1版．长沙：湖南科学技术出版社，1997，140-143
12. Jackevicius CA, Anderson GM, Leiter L, et al. Use of the statins in patients after acute myocardial infarction: does evidence change practice? Arch Intern Med, 2001, 161(2): 183-188
13．血脂治疗现状调查协作组．我国血脂异常治疗现状的调查．中华心血管病杂志，2001，29(1)：15-17
2. Campese VM. Salt sensitivity in hypertension: renal and cardiovascular implications. Hypertension, 1994, 23: 531-550
3. Weinberger MH. Salt sensitivity of blood pressure in humans. Hypertension, 1996, 27(3): 481
4．刘治全．盐敏感性高血压．见：刘力生，龚兰生，陈孟勤等主编．高血压．第1版．北京：人民卫生出版社，2001，512-526
5．刘敏涓，刘泽霖．血栓性疾病的发病机制与危险因素．见：刘泽霖，贺石林，李家增主编．血栓性疾病的诊断与治疗．第1版．北京：人民卫生出版社，2000，8-11
6. Somova L, Mackraj L, Chetty S. Sympathetic and platelet adrenergic activity and salt sensitivity: an experimental study. Methods Find Exp Clin Pharmacol, 1998, 20(8): 657-665
7. Somova L, Mufunda J. Platelet activity and salt sensitivity in the pathogenesis of systemic (essential) hypertension in black Africans. Clin Exp Hypertens, 1993, 15(5): 781-796
8．李玉明，刘治全，杨鼎颐．盐敏感者在高血压人群中的分布及盐敏感性标志的筛选研究．中华心血管病杂志，1994，22：89
9. Bornbeli T, Michele M, Maeberli A. Anticoagulant properties of the vascular endothelium. Thromb Haemost, 1997, 77: 408
10. Ruggeri ZM. Mechanisms initiating platelet thrombus formation. Thromb Haemost, 1997, 78(1): 611
11．刘汉，景本年，李卓江．血栓前状态分子标志物研究进展．国外医学临床生物化学与检验学分册，2000，21(5)：239-240
12. Lip GYH. Target organ damage and the prothrombotic state in hypertension. Hypertension, 2000, 36(6): 975-977
13．欧阳迎春，刘应才，余琴等．原发性高血压血栓前状态标志物变化及其意义．临床心血管病杂志，2002，18(6)：248-250
14. Fuenmayor N, Moreira E, Cubeddu LX. Salt sensitivity is associated with insulin resistance in essential hypertension. Am J Hypertens, 1998, 11(4 Pt 1): 397-402
15. John SW, Krege JH, Oliver PM, et al. Genetic decreases in atrial natfiuretic peptide and salt-sensitive hypertension. Science, 1995, 267: 679-681
1. Barakat K, Wilkinson P, Deaner A, et al. How should age affect management of acute myocardial infarction ? A prospective cohort study. Lancet, 1999, 353(9157): 955-959
2. DeGeare VS, Stone GW, Grines L, et al. Angiographic and clinical characteristics associated with increased inhospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the Primary Angioplasty in Myocardial Infarction Trials). Am J Cardiol, 2000, 86: 30-34
3. Collinson J, Flather MD, Fox KAA, et al. Clinical outcomes, risk stratification and practice patterns of unstable angina and myocardial infarction without ST segment elevation: prospective registry of acute ischaemic syndromes in the UK (PRAIS-UK). Eur Heart J, 2001, 21: 1450-1457
4. Williams D, Kim KS, Adams-Campbell LL. Survival benefit from calcium channel blockers in elderly blacks following acute myocardial infarction. Ethn Dis, 2002, 12(2): 229-233
5. Jousilahti P, Vartiainen E, Tuomilehto J, et al. Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation, 1999, 99: 1165-1172
6. Capewell S, Morrison CE, McMurray JJ. Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and1994. Heart, 1999, 81: 380-386
7．刘晓宁，张春玲，武文君等．年轻人冠心病危险因素分布及聚集状况．中华心血管病杂志，2003，31(2)：87-90
8．王晋军，杨超慧，张颖等．老年冠心病患者冠状动脉病变特点及其危险因素的多元回归分析．中华老年医学杂志，2002，21(3)：172-174
9. Selwyn AP, Kinlay S, Libby P, et al. Atherogenic lipids, vascular dysfunction, and clinical signs of ischemic heart disease. Circulation, 1997, 95(1): 5-7
10. De Meyer GRY, Herman AG. Vascular endothelial dysfunction. Prog Cardiovasc Dis, 1997, 39(4): 325-342
11．党爱民，刘国仗．高血压与心脏．见：刘力生，龚兰生，陈孟勤等主编．高血压．第1版．北京：人民卫生出版社，2001，870-873
12. Franklin SS, Khan SA, Wong ND, et al. Is pulse pressure useful in predicting coronary heart disease ? The Framingham Heart Study. Circulation, 1999, 100: 354-360
13. Amery A, Birkenhager W, Bulpitt CJ, et al. Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: objectives, protocol, and organization. Aging Clin Exp Res, 1991.3: 287-302
14．中国老年收缩期高血压临床试验协作组．中国老年收缩期高血压临床试验总结报告．中华心血管病杂志，1998，26(5)：329-333
15．张宇清，刘国仗．老年收缩期高血压．见：刘力生，龚兰生，陈孟勤等主编．高血压．第1版．北京：人民卫生出版社，2001，495-496
1．徐成斌．论急性冠状动脉综合征他汀类药物早期应用的益处．中华心血管病杂志，2001，29(3)：129-131
2. David D, Waters MD. Early pharmacologic intervention and plaque stability in acute coronary syndromes. Am J Cardiol, 2001, 88(Suppl): 30k-36k
3. The Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4 444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet, 1994, 344: 1383-1389
4. Mannien V, Tenkanen L, Koskinen P. et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study: implications for treatment. Circulation, 1992, 70: 733-737
5. Ericsson CG, Hamsten A, Nilsson J, et al. An angiographic assessment of effects of bezafibrate on progression of coronary artery disease in young male postinfarction patients. Lancet, 1996, 347: 849-853
6. Yoshimura A, Saikawa T, Takakura T, et al. Serum lipid states in elderly patients with acute myocardial infarction: comparison between patients aged 60 to 79 and 80 years and over. J Cardiol, 1995, 25(3): 113-118
7．中华心血管病杂志编辑委员会血脂异常防治对策专题组．血脂异常防治建议．中华心血管病杂志，1997，25(3)：169-175
8．赵水平，张湘瑜，高梅等．小剂量辛伐他汀对急性心肌梗死患者血管内皮功能的影响．中华心血管病杂志，2001，29(3)：136-139
9. Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA, 2001, 285: 1711-1718
10. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA). Early statin treatment following acute myocardial infarction and 1-year survival. JAMA, 2001, 285: 430-436
11．李毅夫，赵水平．胰岛素抵抗综合征．见：赵水平，王钟林，陆宗良主编．临床血脂学．第1版．长沙：湖南科学技术出版社，1997，140-143
12. Jackevicius CA, Anderson GM, Leiter L, et al. Use of the statins in patients after acute myocardial infarction: does evidence change practice? Arch Intern Med, 2001, 161(2): 183-188
13．血脂治疗现状调查协作组．我国血脂异常治疗现状的调查．中华心血管病杂志，2001，29(1)：15-17