CAJ | 학술논문

目的：比较冠心病合并轻度高血压患者在他汀和阿司匹林等治疗降脂达标的基础上分别加用替米沙坦、贝那普利或非洛地平能否进一步获益。方法将伴有1级高血压的冠心病患者162例，随机分为3组：非洛地平组（n＝51），非洛地平缓释片5 mg每日1次；贝那普利组（n＝51），贝那普利10 mg每日1次；替米沙坦组（n＝51），替米沙坦80 mg 每日1次。连续治疗6个月后，检测降压治疗前及治疗6个月后血浆内皮素1（ET-1）、一氧化氮（NO）、高敏C反应蛋白（hsCRP）、白细胞介素6（IL-6）及基质金属蛋白酶9（MMP-9）水平，观察治疗期间心血管事件的发生率。结果治疗前，3组 ET-1、NO、hsCRP、IL-6及 MMP-9水平比较差异均无统计学意义（P＞0．05）；非洛地平组治疗后与治疗前比较 ET-1下降（P ＜0．05），NO 上升（P ＜0．05），hsCRP、IL-6及 MMP-9差异无统计学意义（P＞0．05）；贝那普利组、替米沙坦组治疗后与治疗前比较 ET-1下降及 NO上升更为显著（P＜0．01），且优于非洛地平组（P＜0．05）。hsCRP、IL-6和 MMP-9均显著下降（P＜0．05或＜0．01），替米沙坦组各项炎症指标的下降优于贝那普利组（P＜0．05）。结论冠心病伴轻度高血压患者在降脂达标的基础上，加用贝那普利或替米沙坦改善血管内皮功能的作用优于非洛地平，替米沙坦抑制炎症反应的作用优于贝那普利，可进一步抑制炎症反应，稳定粥样斑块。
목적：비교관심병합병경도고혈압환자재타정화아사필림등치료강지체표적기출상분별가용체미사탄、패나보리혹비락지평능부진일보획익。방법장반유1급고혈압적관심병환자162례，수궤분위3조：비락지평조（n＝51），비락지평완석편5 mg매일1차；패나보리조（n＝51），패나보리10 mg매일1차；체미사탄조（n＝51），체미사탄80 mg 매일1차。련속치료6개월후，검측강압치료전급치료6개월후혈장내피소1（ET-1）、일양화담（NO）、고민C반응단백（hsCRP）、백세포개소6（IL-6）급기질금속단백매9（MMP-9）수평，관찰치료기간심혈관사건적발생솔。결과치료전，3조 ET-1、NO、hsCRP、IL-6급 MMP-9수평비교차이균무통계학의의（P＞0．05）；비락지평조치료후여치료전비교 ET-1하강（P ＜0．05），NO 상승（P ＜0．05），hsCRP、IL-6급 MMP-9차이무통계학의의（P＞0．05）；패나보리조、체미사탄조치료후여치료전비교 ET-1하강급 NO상승경위현저（P＜0．01），차우우비락지평조（P＜0．05）。hsCRP、IL-6화 MMP-9균현저하강（P＜0．05혹＜0．01），체미사탄조각항염증지표적하강우우패나보리조（P＜0．05）。결론관심병반경도고혈압환자재강지체표적기출상，가용패나보리혹체미사탄개선혈관내피공능적작용우우비락지평，체미사탄억제염증반응적작용우우패나보리，가진일보억제염증반응，은정죽양반괴。
Objective To determine if further benefits can be achieved by adding telmisartan,benazepril or felodipine respectively on patients with coronary heart diseases(CHD)and mild hypertension who reached lipid target after treatment with statins and aspirin.Methods One hundred and sixty-two patients with CHD and mild hypertension were randomly assigned to group felodipine (felodipine:5 mg qd,n=51),group benazepril (benazepril:10 mg qd,n=57)or group telmisartan (telmisartan:80 mg qd,n=54).Plasma endothelin-1(ET-1),nitric oxide (NO),high-sensitivity C reactive protein (hsCRP),interleukin-6 (IL-6 )and matrix metalloprotease-9 (MMP-9 )were measured before and after 6 months'treatment.Cardiovascular events were analyzed during treatment.Results ET-1 , NO,hsCRP,IL-6 and MMP-9 levels in three groups showed no significant difference before treatment(P>0.05);In Group Felodipine,the levels of plasma ET-1 decreased and NO increased after treatment (P<0.05).but the levels of plasma hsCRP,IL-6 and MMP-9 did not change significantly(P>0.05).In Group Benazepril and Group Telmisartan, decrease of ET-1 and increase of NO were even significant after treatment(P <0.01),which were more significant than those in Group Benazepril (P < 0.05 ).The levels of inflammatory indices hsCRP,IL-6 and MMP-9 all significantly decreased after benazepril or telmisartan treatment(P<0.05 or <0.01).The decreases of inflammatory indices in Group Telmisartan were more significant than in Group Benazepril(P<0.05).Conclusion On the basis of reaching lipid target,the effects of benazepril or telmisartan on improvement of endothelial function were superior to felodipine in patients with CHD and mild hypertension.The effect of telmisartan on prevention of inflammatory reaction was superior to benazepril,which could further prevent inflammatory reaction and stabilize atherosclerotic plaque.