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重庆三峡医药高等专科学校附属医院心内科,万州,404000
纸质出版日期:2013,
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张后民, 张冬梅. RAS阻断剂治疗原发性高血压过程中醛固酮逃逸与左室肥厚关系研究[J]. 重庆医科大学学报, 2013,36(2):121-125.
ZHANG Houmin, ZHANG Dongmei. Relationship between aldosterone escape phenomena and left ventricular hypertrophy in essential hypertension treated by RAS blocker[J]. Journal of Chongqing Medical University, 2013,36(2):121-125.
张后民, 张冬梅. RAS阻断剂治疗原发性高血压过程中醛固酮逃逸与左室肥厚关系研究[J]. 重庆医科大学学报, 2013,36(2):121-125. DOI:
ZHANG Houmin, ZHANG Dongmei. Relationship between aldosterone escape phenomena and left ventricular hypertrophy in essential hypertension treated by RAS blocker[J]. Journal of Chongqing Medical University, 2013,36(2):121-125. DOI:
目的:探讨伴有左心室肥厚(left ventricular hypertrophy,LVH)的原发性高血压(essential hypertension,EH)患者使用血管紧张素转换酶抑制剂(angiotensin-converting enzyme inhibitor,ACEI)和血管紧张素Ⅱ受体拮抗剂(angiotensinⅡ receptor inhibitor,ARB)治疗后有无醛固酮(aldosterone,Ald)逃逸现象及其与LVH的关系并探讨其机制。方法:将95例伴有LVH EH患者随机分为依那普利组(48例)和厄贝沙坦组(47例),用放射免疫法测定治疗前、治疗后1、3、6个月时血浆AngⅡ、Ald的活性,并用超声心动图测定室间隔厚度、左心室后壁厚度、左心室舒张末横径变化情况及检测血尿常规、血糖、血脂、肝肾功能检查,记录药物不良反应。结果:(1)治疗后2组血压均明显下降,比较两组的血压下降,差异无统计学意义(P >0.05)。(2)依那普利组治疗1、3、6 个月后血AngⅡ较治疗前明显下降差异有统计学意义,治疗3、6 个月后与1 个月比较AngⅡ轻度升高,但差异无统计学意义(P >0.05);而Ald治疗1个月后下降较治疗前差异有统计学意义(P <0.05),治疗3、6 个月后则升高,接近治疗前水平,与治疗前比较差异无统计学意义(P >0.05)。厄贝沙坦组血AngⅡ治疗后1个月与治疗前比较上升,但差异无统计学意义,治疗3、6 个月时较治疗前上升,差异有统计学意义;血Ald 治疗后1、3、6个月浓度明显下降,与治疗前比较差异有统计学意义(P <0.05)。(3)依那普利组、厄贝沙坦组均能逆转LVH。左心室重量、左心室重量指数下降(组内治疗前后比较P <0.05,组间P >0.05)。2组部分患者血浆Ald水平在初期下降,在治疗3个月以后,血浆中Ald水平再度升高且高于治疗前水平即Ald逃逸,治疗6月后依那普利组有19例,厄贝沙坦组2例。有逃逸现象的患者LVH逆转差,差异有统计学意义。结论:应用ACEI或ARB治疗EH患者过程中存在Ald逃逸现象,且该部分患者LVH逆转差,临床工作中应尽早发现并积极对症治疗。
Objective:To investigate the relationship between aldosterone escape phenomena and left ventricular hypertrophy(LVH)in essential hypertension(EH) treated by angiotensin-converting enzyme inhibitor(ACEI) and angiotensinⅡ receptor inhibitor blocker(ARB). Methods:Totally 95 cases of EH complicated with LVH were randomly divided into enalapril group(n=48) and irbesartan group(n=47). AngiotensinⅡ(AngⅡ),aldosterone(Ald),interventricular septal thickness(IVST),left ventricular posterior wall thick-ness(PWT)and left ventricular end diastolic diameter(LVDD) levels were examined before therapy and at 1,3,6 months after thera-py. Results:(1)Levels of blood pressure were decreased in both groups and there was no significant difference between two groups(P >0.05). (2)In enalapril group,AngⅡlevels were all decreased significantly(P <0.05) at 1,3,6 months after therapy. AngⅡlevels were slightly increased at 3,6 months after therapy compared with those at 1 month after therapy,but without statistical differences(P >0.05). Ald levels were decreased significantly at 1 month after therapy compared with those before therapy(P <0.05) but they were increased at 3,6 months after therapy,reaching the levels before therapy(P >0.05). In irbesartan group,AngⅡlevels were increased at 1 month after therapy compared with those before therapy,without statistical differences but they were increased at 3,6 months af-ter therapy compared with those before therapy,with statistical differences(P <0.05). Levels of Ald were all decreased significantly at 1,3,6 months after therapy compared with those before therapy(P <0.05). (3)IVST,PWT,LVDD levels were decreased in both groups after therapy compared with those before therapy(P <0.05) but there was no significance between two groups. Ald levels of some patients(19 patients in enalapril group and 2 patients in irbesar-tan group) were initially decreased but were increased after 3 months’ therapy compared with those before therapy,which was called Ald escape. LVH ameliorations of these paitents were quiet. Conclusions:Ald escape may occur in EH treated by ACEI and ARB. LVH ameliorations in these paitents with Ald escape phenomena are quiet.
依那普利厄贝沙坦醛固酮逃逸左心室肥厚
enalaprilirbesartanaldosterone escapeleft ventricular hypertrophy
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