CAJ | 학술논문

背景: 目前对于高血压凝血和纤溶系统的改变存在着争议 , 而凝血和纤溶系统在高血压血栓栓塞性和 /或出血性并发症的进程中具有关键性作用,因此,检测高血压患者的凝血和纤溶状态 ,并以此为依据合理选用能改善其凝血和纤溶状态的抗高血压药以及据此提出合理的康复介入方案,具有不容忽视的临床价值. 设计: 随机对照的实验研究. 目的: 探讨厄贝沙坦和咪达普利在降压的同时 , 对早期雄性自发性高血压大鼠( spontaneously hypertensive rats, SHR)血浆凝血酶原时间、纤维蛋白原含量、组织型纤溶酶原激活物活性( tissue-type plasminogen activator activity, t-PA:A)、纤溶酶原激活物抑制剂活性( plasminogen activator inhibitor activity, PAI:A)和α 2 纤溶酶抑制物活性(α 2 plasmin inhibitor activity,α 2-PI:A)的影响. 地点、材料和干预:本实验在武汉大学医院检验中心进行. 15周龄雄性 SHR 30只按随机数字表法分为 3组,咪达普利组给予含咪达普利的水 3 mg/( kg· d);厄贝沙坦组给含厄贝沙坦的水 50 mg/( kg· d); SHR对照组和同龄雄性 Wistar Kyoto( WKY)大鼠 (正常血压对照组 )10只以等量蒸馏水代替;采用一期法检测血浆凝血酶原时间,采用凝血酶法检测血浆纤维蛋白原含量,采用发色底物法检测血浆 t-PA:A, PAI:A和α 2-PI:A. 主要观察指标:厄贝沙坦和咪达普利对 SHR凝血、纤溶系统的作用结果并与正常血压对照组( WKY大鼠)进行比较. 结果: 与 WKY组比较: SHR对照组血浆纤维蛋白原含量显著增高( P< 0.01), t-PA:A显著增高( P< 0.05) ,α 2-PI:A显著降低( P< 0.01) , 而凝血酶原时间和 PAI:A无明显变化.与 SHR对照组比较:咪达普利组和厄贝沙坦组经过 3个月治疗血压明显降低( P< 0.01),纤维蛋白原含量显著降低( P< 0.01),α 2-PI:A显著增高( P< 0.01). 结论:早期雄性 SHR血管内凝血与纤溶并存,厄贝沙坦和咪达普利对早期雄性 SHR的干预能逆转 SHR慢性隐性 DIC所致的血栓前状态和动脉粥样硬化,改善其已受损的凝血和纤溶系统,从而降低出血性和 /或血栓栓塞性并发症的危险性. 揹景: 目前對于高血壓凝血和纖溶繫統的改變存在著爭議 , 而凝血和纖溶繫統在高血壓血栓栓塞性和 /或齣血性併髮癥的進程中具有關鍵性作用,因此,檢測高血壓患者的凝血和纖溶狀態 ,併以此為依據閤理選用能改善其凝血和纖溶狀態的抗高血壓藥以及據此提齣閤理的康複介入方案,具有不容忽視的臨床價值. 設計: 隨機對照的實驗研究. 目的: 探討阨貝沙坦和咪達普利在降壓的同時 , 對早期雄性自髮性高血壓大鼠( spontaneously hypertensive rats, SHR)血漿凝血酶原時間、纖維蛋白原含量、組織型纖溶酶原激活物活性( tissue-type plasminogen activator activity, t-PA:A)、纖溶酶原激活物抑製劑活性( plasminogen activator inhibitor activity, PAI:A)和α 2 纖溶酶抑製物活性(α 2 plasmin inhibitor activity,α 2-PI:A)的影響. 地點、材料和榦預:本實驗在武漢大學醫院檢驗中心進行. 15週齡雄性 SHR 30隻按隨機數字錶法分為 3組,咪達普利組給予含咪達普利的水 3 mg/( kg· d);阨貝沙坦組給含阨貝沙坦的水 50 mg/( kg· d); SHR對照組和同齡雄性 Wistar Kyoto( WKY)大鼠 (正常血壓對照組 )10隻以等量蒸餾水代替;採用一期法檢測血漿凝血酶原時間,採用凝血酶法檢測血漿纖維蛋白原含量,採用髮色底物法檢測血漿 t-PA:A, PAI:A和α 2-PI:A. 主要觀察指標:阨貝沙坦和咪達普利對 SHR凝血、纖溶繫統的作用結果併與正常血壓對照組( WKY大鼠)進行比較. 結果: 與 WKY組比較: SHR對照組血漿纖維蛋白原含量顯著增高( P< 0.01), t-PA:A顯著增高( P< 0.05) ,α 2-PI:A顯著降低( P< 0.01) , 而凝血酶原時間和 PAI:A無明顯變化.與 SHR對照組比較:咪達普利組和阨貝沙坦組經過 3箇月治療血壓明顯降低( P< 0.01),纖維蛋白原含量顯著降低( P< 0.01),α 2-PI:A顯著增高( P< 0.01). 結論:早期雄性 SHR血管內凝血與纖溶併存,阨貝沙坦和咪達普利對早期雄性 SHR的榦預能逆轉 SHR慢性隱性 DIC所緻的血栓前狀態和動脈粥樣硬化,改善其已受損的凝血和纖溶繫統,從而降低齣血性和 /或血栓栓塞性併髮癥的危險性.
배경: 목전대우고혈압응혈화섬용계통적개변존재착쟁의 , 이응혈화섬용계통재고혈압혈전전새성화 /혹출혈성병발증적진정중구유관건성작용,인차,검측고혈압환자적응혈화섬용상태 ,병이차위의거합리선용능개선기응혈화섬용상태적항고혈압약이급거차제출합리적강복개입방안,구유불용홀시적림상개치. 설계: 수궤대조적실험연구. 목적: 탐토액패사탄화미체보리재강압적동시 , 대조기웅성자발성고혈압대서( spontaneously hypertensive rats, SHR)혈장응혈매원시간、섬유단백원함량、조직형섬용매원격활물활성( tissue-type plasminogen activator activity, t-PA:A)、섬용매원격활물억제제활성( plasminogen activator inhibitor activity, PAI:A)화α 2 섬용매억제물활성(α 2 plasmin inhibitor activity,α 2-PI:A)적영향. 지점、재료화간예:본실험재무한대학의원검험중심진행. 15주령웅성 SHR 30지안수궤수자표법분위 3조,미체보리조급여함미체보리적수 3 mg/( kg· d);액패사탄조급함액패사탄적수 50 mg/( kg· d); SHR대조조화동령웅성 Wistar Kyoto( WKY)대서 (정상혈압대조조 )10지이등량증류수대체;채용일기법검측혈장응혈매원시간,채용응혈매법검측혈장섬유단백원함량,채용발색저물법검측혈장 t-PA:A, PAI:A화α 2-PI:A. 주요관찰지표:액패사탄화미체보리대 SHR응혈、섬용계통적작용결과병여정상혈압대조조( WKY대서)진행비교. 결과: 여 WKY조비교: SHR대조조혈장섬유단백원함량현저증고( P< 0.01), t-PA:A현저증고( P< 0.05) ,α 2-PI:A현저강저( P< 0.01) , 이응혈매원시간화 PAI:A무명현변화.여 SHR대조조비교:미체보리조화액패사탄조경과 3개월치료혈압명현강저( P< 0.01),섬유단백원함량현저강저( P< 0.01),α 2-PI:A현저증고( P< 0.01). 결론:조기웅성 SHR혈관내응혈여섬용병존,액패사탄화미체보리대조기웅성 SHR적간예능역전 SHR만성은성 DIC소치적혈전전상태화동맥죽양경화,개선기이수손적응혈화섬용계통,종이강저출혈성화 /혹혈전전새성병발증적위험성.
BACKGROUND:Coagulative and fibrinolytic system is commonly recommended for early male spontaneously hypertensive rat(SHR),however,its effects have not been demonstrated in randomized controlled studies. OBJECTIVE:To assess the effects of irbesartan and imidarpril on plasma prothrombin time,fibrinogen,tissue-type plasminogen activator activity(t-PA:A),plasminogen activator inhibitor activity(PAI:A) and α 2 plasmin inhibitor activity(α 2-PI:A) in early male SHR. DESIGN:Randomized controlled study. INTERVENTIONS:Thirty pieces of 15-week old male SHRs were divided into three groups(n=10,each),imidapril grou[(3 mg/(kg· d)],irbesartan group[50 mg/(kg· d)] and SHR control group(equal volume of distilled water) were adminstered by drinking respectively for three months.Ten age-matched male Wistar Kyoto(WKY) rats(healthy control group) were also received equal volume of distilled water by drinking.Plasma prothrombin time were determined with one-step means,Plasma fibrinogen were determined by means of thrombin and Plasma t-PA:A,PAI:A and α 2-PI:A were determined by means of Color Substrate. MAIN OUTCOME MEASURES:The outcome of interventions by irbesartan and imidarpril compared with age-matched male WKY rats. RESULTS:As compared to WKY group,SHR group had singnificantly higher fibrinogen(P< 0.01) and t-PA:A(P< 0.05) but had singnificantly lower α 2-PI:A(P< 0.01),prothrombin time and PAI:A had no significant effact.As compared to SHR group,not only the blood pressure and fibrinogen in imidapril and irbesartan group were significantly decreased(P< 0.01) but also α 2-PI:A were significantly increased(P< 0.01) After three months treatment.In addition,imidapril had higher α 2-PI:A(but P >0.05) than irbesartan group. CONCLUSION:① Intravascular coagulation and fibrinolysis in early male SHRs is concurrent,which indicate that there are chronic disseminated intravscular coagulation(DIC) in early male SHRs,therefore,who are in danger of thromboembolism and/or hemorrhage.② The interventions of imidapril and irbesartan could improve the impaired coagulative and fibrinolytic system.Thus may reduce the complication of hemorrhage and/or thromboembolism.