CAJ | 학술논문

目的探讨不同药物干预对高血压前期患者血管内皮功能及血压的影响.方法选取该院2013年3~8月内科住院或门诊体检初诊为高血压前期患者300例,经筛选排除后,分为以下三组.(1)生活干预组(95例):戒烟、限酒,坚持适量体力劳动,适当限制盐和脂肪的摄入,控制体质量;(2)坎地沙坦组(94例):在生活干预组基础上加用坎地沙坦4 mg/d;(3)氨氯地平组(92例):在生活干预组基础上加用氨氯地平5 mg/d.以肱动脉介导的血管舒张功能(FMD)作为评估血管内皮功能,以颈动脉内膜中层厚度(IMT)作为评估颈动脉粥样硬化程度,定期随访2年,观察血压[收缩压(SBP)、舒张压(DBP)]、FMD、IMT及超敏C反应蛋白(hs-CRP)、生化指标的变化.结果干预2年后,各组体质量指数、hs-CRP较干预前下降,差异有统计学意义(P<0.05),但各组间下降幅度比较,差异无统计学意义(P>0.05);各组FMD、SBP、DBP较干预前改善,且坎地沙坦组和氨氯地平组改善程度大于生活干预组,差异均有统计学意义(P<0.05),但坎地沙坦组和氨氯地平组改善程度比较,差异无统计学意义(P>0.05);各组IMT虽有轻度下降,但与干预前比较,差异无统计学意义(P>0.05).结论在改善生活方式的基础上,加用小剂量的降压药可以改善血管内皮功能,延缓动脉粥样硬化的发生.
목적 탐토불동약물간예대고혈압전기환자혈관내피공능급혈압적영향.방법 선취해원2013년3~8월내과주원혹문진체검초진위고혈압전기환자300례,경사선배제후,분위이하삼조.(1)생활간예조(95례):계연、한주,견지괄량체력노동,괄당한제염화지방적섭입,공제체질량;(2)감지사탄조(94례):재생활간예조기출상가용감지사탄4 mg/d;(3)안록지평조(92례):재생활간예조기출상가용안록지평5 mg/d.이굉동맥개도적혈관서장공능(FMD)작위평고혈관내피공능,이경동맥내막중층후도(IMT)작위평고경동맥죽양경화정도,정기수방2년,관찰혈압[수축압(SBP)、서장압(DBP)]、FMD、IMT급초민C반응단백(hs-CRP)、생화지표적변화.결과 간예2년후,각조체질량지수、hs-CRP교간예전하강,차이유통계학의의(P<0.05),단각조간하강폭도비교,차이무통계학의의(P>0.05);각조FMD、SBP、DBP교간예전개선,차감지사탄조화안록지평조개선정도대우생활간예조,차이균유통계학의의(P<0.05),단감지사탄조화안록지평조개선정도비교,차이무통계학의의(P>0.05);각조IMT수유경도하강,단여간예전비교,차이무통계학의의(P>0.05).결론 재개선생활방식적기출상,가용소제량적강압약가이개선혈관내피공능,연완동맥죽양경화적발생.
Objective To discuss the influence of different drug interventions on the vascular endothelial function and blood pressure in the patients with prehypertension. Methods Totally 300 cases of newly diagnosed prehypertension from the in-patients in the internal medicine department or individuals undergoing the physical examination in the outpatient department of our hospital were from March to August 2013 selected and divided into 3 groups by screening exclusion. (1)The life intervention group(95 cases) was performed the giving up smoking,limiting drinking wine,sticking to a moderate amount of physical labor,ap-propriate limit the intake of salt and fat add,and controlling the body mass;(2)the candesartan group(94 cases) was added with candesartan 4 mg/d on the basis of life intervention;(3)the amlodipine group(92 cases) was added with amlodipine 5 mg/d on the basis of life intervention. The flow-mediated dilatation(FMD) in brachial artery was used for evaluating the vascular endothelial function and the carotid intima-media thickness(IMT) for evaluating the degree of carotid artery atherosclerosis. The 2-year fol-low up was conducted at regular intervals. The changes of SBP,DBP,FMD,IMT,hypersensitive C-reactive protein (hs-CRP) and biochemical indexes were observed. Results After the 2-year intervention,the body mass index and hs-CRP in each group were decreased compared with before intervention,the difference was statistically significant(P<0.05),but the falling range had no statistical difference among groups(P>0.05);FMD,SBP and DBP after intervention in each group were improved compared with before intervention,moreover the improvement degree in the candesartan group and amlodipine group was more than that in the life intervention group, the difference was statistically significant(P<0.05),but the improvement degree had no statistical difference between the candesartan group and the amlodipine group (P>0.05);after 2-year intervention,IMT in each group was declined,but there was no statistical difference compared with before intervention (P>0.05). Conclusion On the basis of improving lifestyle,adding small dose of anti-hypertensive drugs can improve the vascular endothelial function and delay the occurrence of atherosclerosis.