中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2008年
42期
2957-2961
,共5页
赵锋%李建平%王淑玉%关德明%葛均波%胡健%王燕妮%张馥敏%霍勇
趙鋒%李建平%王淑玉%關德明%葛均波%鬍健%王燕妮%張馥敏%霍勇
조봉%리건평%왕숙옥%관덕명%갈균파%호건%왕연니%장복민%곽용
高半胱氨酸%高血压%叶酸%依那普利叶酸片
高半胱氨痠%高血壓%葉痠%依那普利葉痠片
고반광안산%고혈압%협산%의나보리협산편
Homocysteine%Hypertension%Folie acid%Enalapril-folic acid tablet
目的 评价高血压人群基线同型半胱氨酸(Hcy)水平对马来酸依那普利叶酸片(依叶片)降压、降同型半胱氨酸的疗效.方法 在7个研究中心入选456例Ⅰ、Ⅱ级原发性高血压患者,随机分配到3个治疗组中,分别接受依那普利(10 mg)、依叶片10/0.4(依那普利10 ms/叶酸0.4 mg)和依叶片10/0.8(依那普利10mg/叶酸0.8 mg),每13 1次,连续双盲治疗8周.结果 本组原发性高血压人群高同型半胱氨酸血症的发生率达75%.3组治疗均可显著降低血压(均P<0.01).降压疗效在3组间以及各组内不同Hey水平者之间差异均无统计学意义.依叶片(10/0.4和10/0.8)对于高Hcy患者降压或降低Hcy水平均显著优于依那普利组[OR(95%CI):3.0(1.7~5.5),P=0.000和3.3(1.8~5.9),P=0.000],对于低Hey患者依叶片(10/0.4和10/0.8)与依那普利比较疗效差异均无统计学意义[0R(95%CI):1.0(0.3~2.9),P=0.997和1.7(0.5~5.2),P=0.372];同时依叶片(10/0.4和10/0.8)在高Hcy患者组降压或降低Hey疗效均显著优于低Hcy患者组[OR(95%CI):7.5(2.6~21.2),P=0.000和3.5(1.4~8.7),P=0.007].依叶片(10/0.4和10/0.8)对于高Hcy患者降低血压及Hey疗效均显著优于单用依那普利(均P<0.01),对于低Hcy患者依叶片(10/0.8)降Hcy疗效仍显著优于单用依那普利(P=0.016).结论 中国高血压患者高Hcy血症发生率较高,依叶片对Hcy升高的高血压患者可有效控制血压和降低Hcy.在Hcy较低患者,依叶片总体疗效和依那普利片无显著区别,但在控制Hcy方面仍优于依那普利.
目的 評價高血壓人群基線同型半胱氨痠(Hcy)水平對馬來痠依那普利葉痠片(依葉片)降壓、降同型半胱氨痠的療效.方法 在7箇研究中心入選456例Ⅰ、Ⅱ級原髮性高血壓患者,隨機分配到3箇治療組中,分彆接受依那普利(10 mg)、依葉片10/0.4(依那普利10 ms/葉痠0.4 mg)和依葉片10/0.8(依那普利10mg/葉痠0.8 mg),每13 1次,連續雙盲治療8週.結果 本組原髮性高血壓人群高同型半胱氨痠血癥的髮生率達75%.3組治療均可顯著降低血壓(均P<0.01).降壓療效在3組間以及各組內不同Hey水平者之間差異均無統計學意義.依葉片(10/0.4和10/0.8)對于高Hcy患者降壓或降低Hcy水平均顯著優于依那普利組[OR(95%CI):3.0(1.7~5.5),P=0.000和3.3(1.8~5.9),P=0.000],對于低Hey患者依葉片(10/0.4和10/0.8)與依那普利比較療效差異均無統計學意義[0R(95%CI):1.0(0.3~2.9),P=0.997和1.7(0.5~5.2),P=0.372];同時依葉片(10/0.4和10/0.8)在高Hcy患者組降壓或降低Hey療效均顯著優于低Hcy患者組[OR(95%CI):7.5(2.6~21.2),P=0.000和3.5(1.4~8.7),P=0.007].依葉片(10/0.4和10/0.8)對于高Hcy患者降低血壓及Hey療效均顯著優于單用依那普利(均P<0.01),對于低Hcy患者依葉片(10/0.8)降Hcy療效仍顯著優于單用依那普利(P=0.016).結論 中國高血壓患者高Hcy血癥髮生率較高,依葉片對Hcy升高的高血壓患者可有效控製血壓和降低Hcy.在Hcy較低患者,依葉片總體療效和依那普利片無顯著區彆,但在控製Hcy方麵仍優于依那普利.
목적 평개고혈압인군기선동형반광안산(Hcy)수평대마래산의나보리협산편(의협편)강압、강동형반광안산적료효.방법 재7개연구중심입선456례Ⅰ、Ⅱ급원발성고혈압환자,수궤분배도3개치료조중,분별접수의나보리(10 mg)、의협편10/0.4(의나보리10 ms/협산0.4 mg)화의협편10/0.8(의나보리10mg/협산0.8 mg),매13 1차,련속쌍맹치료8주.결과 본조원발성고혈압인군고동형반광안산혈증적발생솔체75%.3조치료균가현저강저혈압(균P<0.01).강압료효재3조간이급각조내불동Hey수평자지간차이균무통계학의의.의협편(10/0.4화10/0.8)대우고Hcy환자강압혹강저Hcy수평균현저우우의나보리조[OR(95%CI):3.0(1.7~5.5),P=0.000화3.3(1.8~5.9),P=0.000],대우저Hey환자의협편(10/0.4화10/0.8)여의나보리비교료효차이균무통계학의의[0R(95%CI):1.0(0.3~2.9),P=0.997화1.7(0.5~5.2),P=0.372];동시의협편(10/0.4화10/0.8)재고Hcy환자조강압혹강저Hey료효균현저우우저Hcy환자조[OR(95%CI):7.5(2.6~21.2),P=0.000화3.5(1.4~8.7),P=0.007].의협편(10/0.4화10/0.8)대우고Hcy환자강저혈압급Hey료효균현저우우단용의나보리(균P<0.01),대우저Hcy환자의협편(10/0.8)강Hcy료효잉현저우우단용의나보리(P=0.016).결론 중국고혈압환자고Hcy혈증발생솔교고,의협편대Hcy승고적고혈압환자가유효공제혈압화강저Hcy.재Hcy교저환자,의협편총체료효화의나보리편무현저구별,단재공제Hcy방면잉우우의나보리.
Objective To investigate the effect of baseline homocysteine (Hey) level on the efficacy of enalapril maleate and folic acid tablet in lowering blood pressure and plasma Hey in patients with mild or moderate essential hypertension. Methods 456 patients with mild or moderate essential hypertension were from 7 hospitals in Southern and Northern China, 196 males and 260 females, aged 18-75, were randomly assigned to one of the 3 groups: Group 1 treated with enalapril 10 mg (n=153) ; Group 2 treated with enalapril maleate and folie acid tablet at the ratio of 10/0.4 (n=151) ; and Group 3 treated with nalapril maleate and folic acid tablet at the ratio of 10/0.8 (n=152). Blood pressure was measureded every 2 weeks and plasma Hcy level was measured before the experiment, 4 weeks after the beginning of experiment, and by the end of experiment. Results Compared with the baseline levels, the blood pressures of the 3 groups were all well controlled (all P<0.01). There was no significant difference among the 3 groups in the efficacy in lowering blood pressure, even after stratification by the baseline Hey level. 75% of all the subjects had elevated plasma Hey level (≥10 μmoi/L). The blood pressure and Hey lowering rates of the subjects with hyperhomecysteinemia in Groups 2 and 3 were 70.9% and 67.0% respectively, both significantly higher than that of Group 1 [ 45.6%, OR (95% CI) : 3.0 (1.7-5.5), P=0.000 and OR= 3.3 (1.8-5.9), P=0.000] , and in lowering Hcy [OR(95%CI) : 7.5(2.6-21.2), P=0.000 and 3.5 (1.4-8.7), P=0. 007 ] subjects with hyperhomocy steinemia. The Hcy lowering efficacy in the patients without hyperhomocysteinemia of Group 3 was significantly higher than that of Group 1 ( P=0.016). Conclusion Hyperhomocysteinemia is s extremely common in Chinese hypertensive patients. Enalapril maleate combine with folic acid tablet shows better efficacy in lowering either blood pressure or Hcy in hypertensive patients with hyperhomocysteinemia.