依拉地平对高血压患者血清sTWEAK水平及左室舒张功能的影响
|
摘要
目的探讨高血压患者左室舒张功能及sTWEAK水平的关系及依拉地平对其的影响。方法符合纳入标准的高血压患者42名,根据心脏超声结果分为左室肥厚组,非肥厚组,均予以依拉地平治疗8周。在治疗前后,采集患者一般资料及生化指标,行超声心动图检查获取患者脉冲多普勒及组织多普勒测得的左室舒张功能相关数据,并取静脉血应用酶联免疫吸附法(ELISA)检测血清sTWEAK水平。治疗期间观察并记录患者不良反应的发生情况。结果与非肥厚组相比,肥厚组患者二尖瓣血流频谱E/A减小、EDT增大(P<0.05或0.01);TDI测二尖瓣瓣环运动速度侧壁及间隔部均值Ea减小、E/Ea增大(P<0.05或0.01);两组间Tei指数无统计学差异(P>0.05);肥厚组较非肥厚组血清sTWEAK水平降低(P<0.01);治疗8周后患者收缩压、舒张压均明显降低,实验室指标HDL-C,UA减低(P<0.05),E峰增加、EDT减小, Ea增大、 E/Ea减小(P<0.05或0.01);治疗前后IVRT、Tei指数无统计学差异(P>0.05)。相关性分析:LVMI与sTWEAK水平、E/Ea均呈正相关(P<0.05);s TWEAK水平与E/Ea呈正相关(P<0.05)。结论高血压患者左室舒张功能不全与左室肥厚相关;依拉地平降压同时可以降低血尿酸水平,升高高密度脂蛋白,改善左室舒张功能。
Objective The purpose of the present study was to explore the relationship between LV diastolic function and plasma sTWEAK level in essential hypertensive patients and the treatment effect of isradipine. Methods Forty two hypertensive subjects were enrolled if they met the criteria, and they were divided into two groups: non-left ventricular hypertrophy(NLVH) group while left ventricular hypertrophy(LVH) group. After 2 weeks of placebo, the participants meeting the entry criteria were treated with isradipine twice a day for 8 weeks. Patients were underwent echocardiographic assessment at baseline and at the end of the study. Blood samples were collected for routine laboratory screening and assessment of sTWEAK by ELISA. Results Left ventricular diastolic function seemed to be poorer in LVH group, as EDT, E/Ea significantly increased and E/A ratio decreased(P<0.05 or P <0.01). No difference was shown in TEI index between the two groups(P>0.05). Compared with the NLVH group, plasma sTWEAK level were increased in LVH group(1285.0±75.5 pg/mL vs 1475.9±157.8 pg/mL, P<0.05). After 8 weeks' treatment, HDL was significantly higher and UA was lower(P<0.05 for both). Compared to baseline, as for diastolic function and filling pressure, EDT, E/Ea significantly increased and E/A ratio decreased(P<0.05; P<0.01; P<0.05 respectively). There were no significant change in TEI index compared to baseline. The LVMI was positively correlated to E/Ea(r=0.537, P<0.05) and plasma sTWEAK level(r=0.718, P<0.05),and plasma sTWEAK level was also positively correlated to E/Ea(r=0.484, P<0.05). Conclusion Left ventricular diastolic dysfunction was associated with left ventricular hypertrophy in patients with essential hypertension; LV hypertrophy and LV diastolic dysfunction were improved after 8 weeks' treatment of isradipine.
Objective The purpose of the present study was to explore the relationship between LV diastolic function and plasma sTWEAK level in essential hypertensive patients and the treatment effect of isradipine. Methods Forty two hypertensive subjects were enrolled if they met the criteria, and they were divided into two groups: non-left ventricular hypertrophy(NLVH) group while left ventricular hypertrophy(LVH) group. After 2 weeks of placebo, the participants meeting the entry criteria were treated with isradipine twice a day for 8 weeks. Patients were underwent echocardiographic assessment at baseline and at the end of the study. Blood samples were collected for routine laboratory screening and assessment of sTWEAK by ELISA. Results Left ventricular diastolic function seemed to be poorer in LVH group, as EDT, E/Ea significantly increased and E/A ratio decreased(P<0.05 or P <0.01). No difference was shown in TEI index between the two groups(P>0.05). Compared with the NLVH group, plasma sTWEAK level were increased in LVH group(1285.0±75.5 pg/mL vs 1475.9±157.8 pg/mL, P<0.05). After 8 weeks' treatment, HDL was significantly higher and UA was lower(P<0.05 for both). Compared to baseline, as for diastolic function and filling pressure, EDT, E/Ea significantly increased and E/A ratio decreased(P<0.05; P<0.01; P<0.05 respectively). There were no significant change in TEI index compared to baseline. The LVMI was positively correlated to E/Ea(r=0.537, P<0.05) and plasma sTWEAK level(r=0.718, P<0.05),and plasma sTWEAK level was also positively correlated to E/Ea(r=0.484, P<0.05). Conclusion Left ventricular diastolic dysfunction was associated with left ventricular hypertrophy in patients with essential hypertension; LV hypertrophy and LV diastolic dysfunction were improved after 8 weeks' treatment of isradipine.
引文
[1]Zile,M.R.and D.L.Brutsaert,New concepts in diastolic dysfunction and diastolic heart failure:Part II:causal mechanisms and treatment[J].Circulation,2002,105(12):1503-8.
[2]Zile,M.R.and D.L.Brutsaert.New concepts in diastolic dysfunction and diastolic heart failure:Part I:diagnosis,prognosis,and measurements of diastolic function[J].Circulation,2002,105(11):1387-93.
[3]Ren,M.Y.and S.J.Sui,The role of TWEAK/Fn14 in cardiac remodeling[J].Mol Biol Rep,2012,39(11):9971-7.
[4]Cheitlin,M.D.,et al.ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography--summary article:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(ACC/AHA/ASE Committee to Update the 1997Guidelines for the Clinical Application of Echocardiography[J]).J Am Coll Cardiol,2003,42(5):954-70.
[5]曹媛,张薇.左室舒张功能障碍评估[J].心血管病学进展,2017,38(06):692-696.
[6]刘羽,宋钰,陈重泽,组织多普勒成像技术评估高血压患者左室舒张功能的价值[J].福建医药杂志,2018,40(01):62-64.
[7]Srivastava,P.M.,L.M.Burrell,P.Calafiore.Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures:which should we use?[J].Eur J Echocardiogr,2005,6(2):97-106.
[8]Tiller,G.,et al.Effects of TWEAK(TNF superfamily member 12)on differentiation,metabolism,and secretory function of human primary preadipocytes and adipocytes[J].Endocrinology,2009,150(12):5373-83.
[9]Jain,M.,et al.A novel role for tumor necrosis factor-like weak inducer of apoptosis(TWEAK)in the development of cardiac dysfunction and failure[J].Circulation,2009,119(15):2058-68.
[10]Wachtell,K.,et al.Change in diastolic left ventricular filling after one year of antihypertensive treatment:The Losartan Intervention For Endpoint Reduction in Hypertension(LIFE)Study[J].Circulation,2002,105(9):1071-6.
[2]Zile,M.R.and D.L.Brutsaert.New concepts in diastolic dysfunction and diastolic heart failure:Part I:diagnosis,prognosis,and measurements of diastolic function[J].Circulation,2002,105(11):1387-93.
[3]Ren,M.Y.and S.J.Sui,The role of TWEAK/Fn14 in cardiac remodeling[J].Mol Biol Rep,2012,39(11):9971-7.
[4]Cheitlin,M.D.,et al.ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography--summary article:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(ACC/AHA/ASE Committee to Update the 1997Guidelines for the Clinical Application of Echocardiography[J]).J Am Coll Cardiol,2003,42(5):954-70.
[5]曹媛,张薇.左室舒张功能障碍评估[J].心血管病学进展,2017,38(06):692-696.
[6]刘羽,宋钰,陈重泽,组织多普勒成像技术评估高血压患者左室舒张功能的价值[J].福建医药杂志,2018,40(01):62-64.
[7]Srivastava,P.M.,L.M.Burrell,P.Calafiore.Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures:which should we use?[J].Eur J Echocardiogr,2005,6(2):97-106.
[8]Tiller,G.,et al.Effects of TWEAK(TNF superfamily member 12)on differentiation,metabolism,and secretory function of human primary preadipocytes and adipocytes[J].Endocrinology,2009,150(12):5373-83.
[9]Jain,M.,et al.A novel role for tumor necrosis factor-like weak inducer of apoptosis(TWEAK)in the development of cardiac dysfunction and failure[J].Circulation,2009,119(15):2058-68.
[10]Wachtell,K.,et al.Change in diastolic left ventricular filling after one year of antihypertensive treatment:The Losartan Intervention For Endpoint Reduction in Hypertension(LIFE)Study[J].Circulation,2002,105(9):1071-6.