本文關(guān)鍵詞：硝苯地平控釋片對(duì)動(dòng)脈脈搏波傳導(dǎo)速度增高的輕度高血壓患者的早期干預(yù)　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 硝苯地平控釋片 鈣通道阻滯劑 高血壓 動(dòng)脈脈搏波傳導(dǎo)速度 動(dòng)脈硬化

【摘要】：目的:高血壓是最常見(jiàn)的慢性病,也是心腦血管病最主要的危險(xiǎn)因素,嚴(yán)重危害人類的健康。治療高血壓的主要目的是最大限度的降低心腦血管并發(fā)癥的發(fā)生和死亡的總體風(fēng)險(xiǎn)。因此,應(yīng)在控制血壓值的同時(shí),對(duì)檢出的血管病變等亞臨床靶器官損害進(jìn)行有效干預(yù),讓患者的遠(yuǎn)期預(yù)后得到改善。動(dòng)脈脈搏波傳導(dǎo)速度(pulse wave velocity,PWV)是動(dòng)脈僵硬度的良好指示器,年齡、性別、血壓等都是PWV的決定因素。在對(duì)高血壓進(jìn)行積極干預(yù),尤其是早期干預(yù)時(shí),可通過(guò)這個(gè)指標(biāo)檢測(cè)以及評(píng)估藥物干預(yù)血管病變的效果。很多研究表明,明確增加動(dòng)脈順應(yīng)性的藥物有鈣通道阻滯劑、血管緊張素轉(zhuǎn)換酶抑制劑、血管緊張素II受體拮抗劑和硝酸酯類,但降壓藥物的機(jī)制不同,對(duì)心血管的保護(hù)作用也不同。近20年來(lái),鈣通道阻滯劑(calcium channel blockers,CCB)作為阻滯細(xì)胞膜鈣通道來(lái)降壓的化學(xué)制劑,廣泛應(yīng)用于高血壓的降壓治療,通過(guò)有效降壓可顯著降低冠心病患者心肌梗死、卒中和心源性死亡等心血管不良事件的發(fā)生率。近來(lái)研究表明,鈣通道阻滯劑可以重塑血管內(nèi)皮,改善血管動(dòng)脈硬化,并且在將患者血壓降至平穩(wěn)后仍有改善動(dòng)脈硬化的作用,這說(shuō)明鈣通道阻滯劑有不依賴降壓作用的改善動(dòng)脈僵硬度的作用。二氫吡啶類的鈣通道阻滯劑硝苯地平控釋片因?yàn)槠溆行Ы祲鹤饔煤土己玫哪褪苄砸延糜谛难芗膊∨R床治療多年,既往有小樣本研究表明硝苯地平在降壓時(shí)顯著降低PWV的水平,但大規(guī)模的臨床研究國(guó)內(nèi)還未見(jiàn)報(bào)道。本課題選取60例新診斷為輕度高血壓合并PWV增高的18到75歲患者,給予患者硝苯地平控釋片降壓治療,共隨訪24周,期間監(jiān)測(cè)血壓、心率、臂-踝動(dòng)脈脈搏波傳導(dǎo)速度(brachial-ankle pulse wave velocity,ba PWV)等指標(biāo)。目的是評(píng)價(jià)硝苯地平控釋片在高血壓病程早期對(duì)動(dòng)脈僵硬度的干預(yù)情況,以及是否存在不依賴于降壓作用的改善PWV的效果,以用于指導(dǎo)目前高血壓的診斷與治療。方法:研究對(duì)象為2013年12月至2014年12月于河北醫(yī)科大學(xué)第二醫(yī)院新診斷為輕度高血壓合并PWV增高的60名患者。本研究為單中心、單組、前瞻性、IV期臨床研究。研究開(kāi)始給予患者硝苯地平控釋片(30mg 1/日)治療4周,若血壓降至140/90mm Hg以下,則維持該劑量;若血壓未達(dá)標(biāo),則劑量倍增,予硝苯地平控釋片60mg 1/日治療,若硝苯地平控釋片60mg1/日治療8周后后仍未達(dá)標(biāo),治療醫(yī)生可根據(jù)臨床常規(guī)進(jìn)行治療。在基線、2周、4周、8周、12周、18周及24周進(jìn)行隨訪,測(cè)量患者的血壓、心率,直至試驗(yàn)結(jié)束。在基線、4周、12周和24周時(shí)測(cè)量患者的臂-踝動(dòng)脈脈搏波傳導(dǎo)速度(ba PWV)。數(shù)據(jù)采用SPSS17.0進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料服從正態(tài)分布時(shí)用均數(shù)?標(biāo)準(zhǔn)差(x±s)表示,計(jì)數(shù)資料采用百分?jǐn)?shù)率表示,基線、4周、12周、24周測(cè)量的ba PWV、血壓各自之間用重復(fù)測(cè)量方差分析比較,兩者之間做雙變量直線相關(guān)分析(Person相關(guān)分析),治療4周后ba PWV的變化與血壓的變化同樣做雙變量直線相關(guān)分析,與吸煙、飲酒、膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、血糖、BMI、年齡、性別做多元線性回歸分析。P0.05認(rèn)為有統(tǒng)計(jì)學(xué)差異。結(jié)果:1降壓治療后SBP、DBP、HR、MAP、PP變化:(1)治療24周后24小時(shí)動(dòng)態(tài)血壓較基線比有明顯降低(P0.001);降壓治療4周、12周、24周后SBP、DBP、MAP、PP均較治療前明顯降低(P0.001),均有統(tǒng)計(jì)學(xué)意義;(2)降壓治療12周、24周后的SBP、DBP、MAP、PP較降壓治療4周時(shí)無(wú)明顯變化(P0.05);(3)降壓治療4周、12周、24周時(shí)HR較治療前均未見(jiàn)明顯變化(P0.05)。2降壓治療前后ba PWV的變化:(1)硝苯地平控釋片降壓治療4周12周、24周后ba PWV較治療前均可見(jiàn)明顯降低(P0.001);(2)治療12周較治療4周時(shí)及治療24周時(shí)較12周時(shí)ba PWV無(wú)明顯變化(P0.05)。3 ba PWV與血壓的相關(guān)性分析:基線、4周、12周、24周的ba PWV與SBP的相關(guān)系數(shù)為0.99,P=0.01;與DBP的相關(guān)系數(shù)為0.987,P=0.013;與MAP的相關(guān)系數(shù)為0.992,P=0.008,均有統(tǒng)計(jì)學(xué)意義,與PP的相關(guān)系數(shù)為0.943,P=0.057,無(wú)統(tǒng)計(jì)學(xué)意義。4△ba PWV0的相關(guān)因素分析:△ba PWV0與△SBP0的相關(guān)系數(shù)為0.327,P=0.008;與△DBP0的相關(guān)系數(shù)為0.347,P=0.005;與△MAP0的相關(guān)系數(shù)為0.388,P=0.002,均有統(tǒng)計(jì)學(xué)意義�！鱞a PWV0與△PP0、吸煙、飲酒、膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、血糖、BMI、年齡、性別等因素做多元性線性回歸分析均無(wú)相關(guān)性(P0.05)。結(jié)論:硝苯地平控釋片對(duì)于輕度高血壓合并ba PWV增高的患者,在有效降壓的同時(shí),能顯著降低ba PWV,使動(dòng)脈硬化改善;而且ba PWV的降低與其降壓作用相關(guān),這種降低ba PWV的作用在用藥早期(4周內(nèi))即可出現(xiàn),并與收縮壓、舒張壓、平均壓的降低相關(guān)。未觀察到除降壓外改善PWV的作用。
[Abstract]:Objective: hypertension is the most common chronic disease, and it is also the most important risk factor of cardiovascular and cerebrovascular disease, which seriously endangers human health. The main purpose of the treatment of hypertension is to minimize the overall risk of the occurrence and death of cardiovascular and cerebrovascular complications. Therefore, while the blood pressure is controlled, the subclinical target organ damage, such as the detected vascular lesions, should be effectively intervened and the long-term prognosis of the patients should be improved. Pulse wave velocity (pulse wave, velocity, PWV) is a good indicator of arterial stiffness, age, gender, blood pressure are important determinants of PWV. Active intervention in hypertension, especially early intervention, can be used to detect and evaluate the effects of drug intervention on vascular lesions. Many studies have shown that drugs that increase arterial compliance include calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and nitrates. However, the mechanisms of antihypertensive drugs are different in cardiovascular protection. In the past 20 years, calcium channel blockers (calcium channel, blockers, CCB) of chemical agents as blocking calcium channel in cell membrane to buck, Buck widely used in the treatment of hypertension, through effective antihypertensive therapy can significantly reduce the incidence of cardiovascular disease in patients with myocardial infarction, stroke and cardiac death and other adverse events. Recent studies have shown that calcium channel blockers can remold vascular endothelium, improve vascular atherosclerosis, and improve arteriosclerosis after lowering blood pressure to patients. This indicates that calcium channel blockers have no effect on arterial stiffness. Calcium channel blockers Nifedipine Controlled Release Tablets two dihydropyridine because of its effective antihypertensive effect and good tolerance has been used in clinical treatment of cardiovascular disease for many years, with a history of small sample studies show that nifedipine significantly reduced levels of PWV in the buck, but large-scale clinical research has not been reported at home. This study selected 60 patients with newly diagnosed mild hypertension with PWV increased 18 to 75 years old were treated with Nifedipine Controlled Release Tablets blood pressure, were followed for 24 weeks during the monitoring of blood pressure, heart rate, brachial ankle pulse wave velocity (brachial-ankle pulse wave velocity, BA PWV) and other indicators. Objective to evaluate the intervention of Nifedipine Controlled Release Tablets on arterial stiffness in the early stage of hypertension, and whether there is any effect of improving PWV without lowering blood pressure, so as to guide the diagnosis and treatment of hypertension. Methods: from December 2013 to December 2014, 60 patients with mild hypertension and increased PWV were newly diagnosed at the second hospital of Hebei Medical University. This study is a single center, single group, prospective, IV phase clinical study. The start of the study were given Nifedipine Controlled Release Tablets (30mg 1/) for 4 weeks, if the blood pressure dropped to 140/90mm following Hg, while maintaining the dose; if the blood pressure did not reach, it dose doubled to Nifedipine Controlled Release Tablets 60mg 1/, Nifedipine Controlled Release Tablets 60mg1/, if the treatment, after 8 weeks of treatment, after treatment has not yet reached, doctors may be treated according to the clinical routine. Follow up at baseline, 2, 4, 8, 12, 18, and 24 weeks to measure the patient's blood pressure and heart rate until the end of the test. At baseline, 4 weeks, 12 weeks and 24 weeks were measured brachial ankle pulse wave velocity (BA PWV). The data were analyzed by SPSS17.0. The measurement data obey normal distribution with mean? Standard deviation (x + s), count data using percentage rate, comparative analysis of baseline, 4 weeks, 12 weeks, 24 weeks, their blood pressure measurement of BA PWV by repeated measurement of variance analysis, linear correlation between the two variables do (Person correlation analysis), changes in PWV and blood pressure changes of Ba after 4 weeks to do the same for the analysis of bivariate linear correlation, drinking, smoking, cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, blood glucose, BMI, age and gender do multiple linear regression analysis. P0.05 thinks there is a statistical difference. Results: the changes of SBP, DBP, HR 1, MAP, PP after antihypertensive treatment: (1) after 24 weeks of treatment, 24 hour ambulatory blood pressure was lower than the baseline (P0.001); antihypertensive treatment for 4 weeks, 12 weeks and 24 weeks after SBP, DBP, MAP and PP were significantly lower than those before treatment (P0.001), there was statistically significant; (2) antihypertensive treatment for 12 weeks and 24 weeks after SBP, DBP, MAP, PP with antihypertensive treatment no significant change at 4 weeks (P0.05); (3) antihypertensive treatment for 4 weeks, 12 weeks and 24 weeks HR than before treatment showed no significant change (P0.05). 2, the change of BA PWV before and after treatment: (1) after 4 weeks, 12 weeks and 24 weeks, the BA PWV of Nifedipine Controlled Release Tablets decreased significantly compared with that before treatment (P0.001). (2) there was no significant change in BA PWV at 12 weeks compared with 4 weeks and 24 weeks. Correlation analysis of 3 BA PWV and blood pressure: the correlation coefficient of BA PWV and SBP at baseline, 4 weeks, 12 weeks, 24 weeks was 0.99 P=0.01; and the correlation coefficient DBP is 0.987, P=0.013; the correlation coefficient of MAP was 0.992, P=0.008, were statistically significant, and the correlation coefficient PP was 0.943. P=0.057, no statistical significance. Analysis of related factors of 4 BA PWV0: correlation coefficient of delta BA PWV0 and delta SBP0 is 0.327, P=0.008; the correlation coefficient and DBP0 is 0.347, P=0.005; the correlation coefficient and MAP0 is 0.388, P=0.002, were statistically significant. BA PWV0 and PP0, smoking, drinking, cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, blood glucose, BMI, age, gender and other factors to do multiple linear regression analysis showed no correlation (P0.05). Conclusion: Nifedipine Controlled Release Tablets can significantly reduce BA PWV and improve arteriosclerosis in patients with mild hypertension and BA PWV increase, while the decrease of BA PWV is associated with its antihypertensive effect, which reduces the role of BA PWV in drug use.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R544.1

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4 衛(wèi)東;硝苯地平控釋片研究新進(jìn)展[N];中國(guó)醫(yī)藥報(bào);2004年

5 張曉松;硝苯地平控釋片更適于亞洲人群的高血壓治療[N];醫(yī)藥經(jīng)濟(jì)報(bào);2006年

6 本報(bào)記者 慕欣;從《CAD共識(shí)》看CCB的選擇[N];醫(yī)藥經(jīng)濟(jì)報(bào);2010年

7 齊 崔民彥 華辛 陸志城 華文;恙在內(nèi)，，效者必達(dá)[N];醫(yī)藥經(jīng)濟(jì)報(bào);2002年

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1 汪雁;硝苯地平控釋片對(duì)動(dòng)脈脈搏波傳導(dǎo)速度增高的輕度高血壓患者的早期干預(yù)[D];河北醫(yī)科大學(xué);2015年

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