摘要
目的探讨苯磺酸左旋氨氯地平片联合叶酸片治疗H型高血压的疗效,评估长效钙离子拮抗剂类降压药联合叶酸片对H型高血压治疗及脑卒中预防的效果。方法选择符合标准的240例Ⅰ级、Ⅱ级原发性H型高血压患者,随机分为苯磺酸左旋氨氯地平联合叶酸组120例和马来酸依那普利叶酸组120例。在入组前测量所有患者的血压、血糖、血脂、血清同型半胱氨酸水平、以及颈动脉内中膜厚度及斑块积分,在干预3个月后复查两组患者的血压以及血清同型半胱氨酸水平;干预1年后复查颈动脉内中膜厚度及斑块积分;1年内随时记录患者的脑血管病事件的发生等指标。结果干预3个月后苯磺酸左旋氨氯地平联合叶酸组与马来酸依那普利叶酸组降压和降血清同型半胱氨酸作用明显,与干预前比较差异有统计学意义(P<0.05);苯磺酸左旋氨氯地平联合叶酸组同时降压降血清同型半胱氨酸的有效率为83.3%(100/120),马来酸依那普利叶酸组为75.0%(90/120),两组间比较差异无统计学意义(χ2=2.526,P=0.112)。1年后复查颈动脉超声显示两组在颈动脉内中膜厚度和斑块积分上都较前明显改善,差异具有统计学意义(P<0.05);但两组之间比较差异无统计学意义(P>0.05)。随访1年内苯磺酸左旋氨氯地平联合叶酸组发生脑血管疾病7例,发生率为6.5%(7/108);马来酸依那普利叶酸组发生脑血管病5例,发生率是5.0%(5/100)。两组间比较差异无统计学意义(χ2=0.21,P=0.65)。结论苯磺酸左旋氨氯地平片联合叶酸片在治疗Ⅰ级、Ⅱ级H型高血压患者在同时降压降同型半胱氨酸方面效果显著,能够明显改善颈动脉内中膜厚度,缓解动脉粥样硬化速度,有效减少脑血管事件的发生,对H型高血压患者的疗效与马来酸依那普利叶酸片相当。
Objective To the discuss the effect of the levamlodipine besylate tablets combined with folic acid tablets on the treatment of H - type hypertension, and to give correct investigation of the efficacy of long - acting calcium antagonists combined with folic acid tablets on the treatment of H - type hypertension and stroke prevention. Methods Totally 240 patients were diagnosed as H - type hypertension. All these pa- tients were randomly divided as treatment group Shi Huida （levamlodipine besylate） combined with folic acid tablets （0.8 mg/d） （n = 120） and control group the blade （enalapril maleate and folic acid tablets, 10 mg/0.8 mg） （n = 120 ）. Before entering the group, the patients had to meas- ure the blood pressure, blood glucose, blood lipid, serum homocysteine levels, and carotid intima media thickness and plaque score. After 3 months intervention, two groups of patients were measured again the blood pressure and serum homocysteine level. After the 12 months, carotid ar- tery intima media thickness and plaque score were measured. The cerebrovascular diseases （ including cerebral infarction, transient ischemic at- tack, the recurrence of stroke and cerebrovascular disease death） were recorded at any time within 12 months in patients. Results After 3 months of treatment, both Shi Huida （ Levamlodipine besylate） combined with folic acid tablets group and the blade （ enalapril maleate and folic acid tab- lets, 10 mg/0.8 mg） group can reduce the blood pressure and serum homocysteine significantly, there was a significant difference （ P 〈 0.05 ）. The efficiency of the treatment group on reduction of blood pressure and serum homocysteine in the same time was 83.3% （100/120） , while the control group was 75.0% （90/120）. The comparison of the two groups did not show statistically significant differences （Х^2 = 2. 526, P = 0. 112 ）. After 1 years treatment, the carotid ultrasound examination showed that the carotid intima media thickness and plaque score were significant- ly improved than before in the two groups, which had a significant difference （ P 〈 0.05 ）. But the comparison between the two groups was not statistically significant （ P 〉 0. 05 ）. During 1 years follow - up, there were 7 cases of cerebral vascular diseases in the treatment group. The inci- dence rate was 6.5% （7/108）, while the control group of cerebral vascular diseases were 5 cases. The incidence was 5% （5/100） in the control group. Comparison between the two groups was not statistically significant （ Х^2 = 0.21, P = 0.65 ）. Conclusion Levamlodipine besylate com- bined with folie acid tablets in the treatment of patients with stage Ⅰ , Ⅱ H - type hypertension at the same time can reduce blood pressure and the decreased level of serum homocysteine remarkable. This method can effectively slow down the arteriosclerosis progress, stablize IMT, and effec- tively reduce the incidence of cerebral vascular events （ including cerebral infarction, transient cerebral ischemic attack, the recurrence of stroke and cerebrovascular disease death）. Levamlodipine besylate combined with folic acid tablets is same with the enalapri maleate folic acid tablets on the treatment of H - type hypertension.
出处
《临床和实验医学杂志》
2014年第8期613-618,共6页
Journal of Clinical and Experimental Medicine
作者简介
首都医科大学附属北京友谊医院在读研究生，原工作单位为北京市海淀区清河社区卫生服务中心
通讯作者：刘力戈，E—mail：lige2128@sina．com
