中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2005年
15期
205-207
,共3页
覃秀川%徐彬%张墨玲%李建开%韩宏毅%刘蓉
覃秀川%徐彬%張墨玲%李建開%韓宏毅%劉蓉
담수천%서빈%장묵령%리건개%한굉의%류용
心肌梗塞%依那普利/治疗应用%脂蛋白类%自由基
心肌梗塞%依那普利/治療應用%脂蛋白類%自由基
심기경새%의나보리/치료응용%지단백류%자유기
背景:许多研究已表明血管紧张素转换酶抑制剂具有独立于降压以外抗动脉粥样硬化的血管保护作用,但其机制未完全明确.目的:研究血管紧张素转换酶抑制剂对急性心肌梗死患者脂蛋白(a)和氧自由基的影响,探讨血管紧张素转换酶抑制剂抗动脉粥样硬化的机制.设计:以急性心肌梗死患者为研究对象的观察对比研究.单位:解放军总医院南二科.对象:选择2001-04/2002-08在天津港口医院心内科住院的急性心肌梗死患者35例,男19例,女16例,年龄42～75岁,平均(62±9)岁.随机分为两组,治疗组20例,对照组15例.纳入标准:符合世界卫生组织的急性心肌梗死诊断标准者;排除标准:肾功能不全、休克、低血压者及曾服血管紧张素转换酶抑制剂有过敏及明显咳嗽史者.所有患者于发病前2周未服用过血管紧张素转换酶抑制剂并且同意参加本研究.方法:治疗组于心梗后第3天晨起予依那普利5 mg口服1次,若无首剂低血压反应,于心梗后第4天开始口服依那普利5 mg/次,2次/d,连续2周,再予10 mg/次,2次/d,连续2周.对照组不用依那普利.分别于服药前、服药后2周和4周时两组同时取血,检测血清中的脂蛋白(a)、氧自由基、三酰甘油、总胆固醇、高密度脂蛋白胆固醇和载脂蛋白(a).主要观察指标:两组患者用药前后三酰甘油、总胆固醇、高密度脂蛋白胆固醇、载脂蛋白(a)及血清中的脂蛋白(a)、氧自由基水平的比较.结果:依那普利能明显降低急性心肌梗死患者氧自由基水平,用药前、用药2周和用药4周的氧自由基水平分别为(1 423.14±216.23),(1 076.62±287.12)和(566.57±138.02)U/mL(t=2.937,3.571,P＜0.01),但不影响脂蛋白(a)和血脂水平(P＞0.05).结论:依那普利通过抗氧化作用来抑制急性心肌梗死患者动脉粥样硬化的进程,改善其预后,但不降低血脂水平,为依那普利抑制急性心肌梗死患者动脉粥样硬化的机制提供了理论参考.
揹景:許多研究已錶明血管緊張素轉換酶抑製劑具有獨立于降壓以外抗動脈粥樣硬化的血管保護作用,但其機製未完全明確.目的:研究血管緊張素轉換酶抑製劑對急性心肌梗死患者脂蛋白(a)和氧自由基的影響,探討血管緊張素轉換酶抑製劑抗動脈粥樣硬化的機製.設計:以急性心肌梗死患者為研究對象的觀察對比研究.單位:解放軍總醫院南二科.對象:選擇2001-04/2002-08在天津港口醫院心內科住院的急性心肌梗死患者35例,男19例,女16例,年齡42～75歲,平均(62±9)歲.隨機分為兩組,治療組20例,對照組15例.納入標準:符閤世界衛生組織的急性心肌梗死診斷標準者;排除標準:腎功能不全、休剋、低血壓者及曾服血管緊張素轉換酶抑製劑有過敏及明顯咳嗽史者.所有患者于髮病前2週未服用過血管緊張素轉換酶抑製劑併且同意參加本研究.方法:治療組于心梗後第3天晨起予依那普利5 mg口服1次,若無首劑低血壓反應,于心梗後第4天開始口服依那普利5 mg/次,2次/d,連續2週,再予10 mg/次,2次/d,連續2週.對照組不用依那普利.分彆于服藥前、服藥後2週和4週時兩組同時取血,檢測血清中的脂蛋白(a)、氧自由基、三酰甘油、總膽固醇、高密度脂蛋白膽固醇和載脂蛋白(a).主要觀察指標:兩組患者用藥前後三酰甘油、總膽固醇、高密度脂蛋白膽固醇、載脂蛋白(a)及血清中的脂蛋白(a)、氧自由基水平的比較.結果:依那普利能明顯降低急性心肌梗死患者氧自由基水平,用藥前、用藥2週和用藥4週的氧自由基水平分彆為(1 423.14±216.23),(1 076.62±287.12)和(566.57±138.02)U/mL(t=2.937,3.571,P＜0.01),但不影響脂蛋白(a)和血脂水平(P＞0.05).結論:依那普利通過抗氧化作用來抑製急性心肌梗死患者動脈粥樣硬化的進程,改善其預後,但不降低血脂水平,為依那普利抑製急性心肌梗死患者動脈粥樣硬化的機製提供瞭理論參攷.
배경:허다연구이표명혈관긴장소전환매억제제구유독립우강압이외항동맥죽양경화적혈관보호작용,단기궤제미완전명학.목적:연구혈관긴장소전환매억제제대급성심기경사환자지단백(a)화양자유기적영향,탐토혈관긴장소전환매억제제항동맥죽양경화적궤제.설계:이급성심기경사환자위연구대상적관찰대비연구.단위:해방군총의원남이과.대상:선택2001-04/2002-08재천진항구의원심내과주원적급성심기경사환자35례,남19례,녀16례,년령42～75세,평균(62±9)세.수궤분위량조,치료조20례,대조조15례.납입표준:부합세계위생조직적급성심기경사진단표준자;배제표준:신공능불전、휴극、저혈압자급증복혈관긴장소전환매억제제유과민급명현해수사자.소유환자우발병전2주미복용과혈관긴장소전환매억제제병차동의삼가본연구.방법:치료조우심경후제3천신기여의나보리5 mg구복1차,약무수제저혈압반응,우심경후제4천개시구복의나보리5 mg/차,2차/d,련속2주,재여10 mg/차,2차/d,련속2주.대조조불용의나보리.분별우복약전、복약후2주화4주시량조동시취혈,검측혈청중적지단백(a)、양자유기、삼선감유、총담고순、고밀도지단백담고순화재지단백(a).주요관찰지표:량조환자용약전후삼선감유、총담고순、고밀도지단백담고순、재지단백(a)급혈청중적지단백(a)、양자유기수평적비교.결과:의나보리능명현강저급성심기경사환자양자유기수평,용약전、용약2주화용약4주적양자유기수평분별위(1 423.14±216.23),(1 076.62±287.12)화(566.57±138.02)U/mL(t=2.937,3.571,P＜0.01),단불영향지단백(a)화혈지수평(P＞0.05).결론:의나보리통과항양화작용래억제급성심기경사환자동맥죽양경화적진정,개선기예후,단불강저혈지수평,위의나보리억제급성심기경사환자동맥죽양경화적궤제제공료이론삼고.
BACKGROUND: Many studies have suggested that angiotensin-converting enzyme inhibitors(ACEI) protect blood vessels through anti-atherosclerosis independent of lowering blood pressure, but its mechanism is still unclear.OBJECTIVE: To investigate the anti-atherosclerotic mechanism of ACEI by observing the effects of Enalapril on lipoprotein(a) and oxygen free radicals in patients with acute myocardial infarction (AMI) .DESIGN: A controlled study based on the observation of the patients with AMI.SETTING: Second Department of the South Building, General Hospital of Chinese PLAPARTICIPANTS: Thirty-five inpatients with AMI(19 males and 16 females, aged 42 -75 years old, and averaged (62 ± 9) years old and hospitalized at the Department of Cardiology of Tianjin Harbor Hospital from April 2001 to August 2002 were chosen. These patients were randomly divided into 2 groups: the therapeutic group(20 cases) and the control group(15cases). Inclusion criteria: the diagnosis of patients with AMI was confirmed by WHO criteria. Exclusion criteria: patients with renal dysfunction, shock,hypotension, a history of allergy to ACEI, and a history of severe cough induced by ACEI. All patients had not taken ACEI in the past 2 weeks and agreed to participate in this study.METHODS: On early morning of the third day after AMI, patients in the treatment group took 5 mg of Enalapril one time. If they had no first-dose reaction of hypotension, on the fourth day after AMI, the patients of the treatment group were given a dose of 5 mg twice per day for the following 2 weeks. Then, they were given the drug at a dose of 10 mg twice per day for 2 weeks. The patients in the control group were not given Enalapril. Blood samples were taken respectvely prior to the administration and 2 weeks and 4 weeks after the administration in the two groups. Serum content of lipoprotein(a), oxygen free radicals, triglyceride, total cholesterol, high density lipoprotein(HDL) cholesterol, Apo(a) were measured.MAIN OUTCOME MEASURES: We compared the level of serum of lipoprotein (a), oxygen free radicals (OFR), triglyceride, total cholesterol,HDL cholesterol, Apo(a) pre-treatment and post-treatment respectively in patients of the two groups.RESULTS: Serum levels of OFR were significantly lowered in the treatment group, which were(1 423.14±216.23), (1 076.62±287.12) and (566.57 ± 138.02) U/mL respectively 2 weeks and 4 weeks before and after the treatment(t =2. 937, 3. 571, P ＜0. 01), but there were no significant changes in serum concentrations of lipoprotein(a) and lipids( P ＞ 0.05) .CONCLUSION: Enalapril improved the prognosis of patients with AMI by antioxidation, but not by lowering the serum levels of lipoprotein(a) and lipids. The study can serve as a theoretical reference that the mechanism of Enalapril might inhibit atherosclerosis in patients with AMI.
