本文選題：血管緊張素轉化酶抑制劑 + 同型半胱氨酸　； 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]以H型高血壓患者為研究對象,探究葉酸聯(lián)合血管緊張素轉化酶抑制劑治療對其血清中血管緊張素轉化酶活性的影響,并進一步從基因層面上探討血管緊張素轉化酶基因mRNA表達和相關因素分析,為H型高血壓的治療提供更多臨床依據(jù)。[方法]選取2016年1月份至10月份昆明市第一人民醫(yī)院門診及住院部收治的H型高血壓患者110例,簽署知情同意書后,依據(jù)隨機化原則分為A組、B組,其中A組為研究組,B組為對照組,每組均為55人。收集所有入選對象的一般資料包括姓名、性別、年齡、體重指數(shù)(body mass index,BMI);血液檢測資料包括空腹血糖(fasting blood glucose,FBG)、同型半胱氨酸(homocysteine,Hcy)、葉酸、血管緊張素轉化酶(angiotensin-converting enzyme,ACE)活性、肌酐(creatinine,CREA)、甘油三酯(triglyceride,TG)、總膽固醇(total cholesterol,TC)、高密度脂蛋白膽固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白膽固醇(low-density lipoprotein cholesterol,LDL-C),收縮壓(systolic blood pressure,SBP),舒張壓(diastolic blood pressure,DBP),同時監(jiān)測入選患者的肝腎功能、藥物不良反應及相應并發(fā)癥。A組采用葉酸0.8 mg聯(lián)合ACEI代表類藥物培哚普利叔丁胺片4mg治療,B組采用培哚普利叔丁胺片4mg單獨治療,過程中電話隨訪,隨時排外不符合要求的受試者,觀察對比剩余患者經(jīng)3個月治療后兩組血壓下降程度、血清HCY濃度及血清血管緊張素轉化酶活性的改變及3個月后患者血壓達標率和降壓有效率。并通過對血管緊張素轉化酶總RNA提取及擴增,計算H型高血壓患者中ACE基因mRNA表達含量,探討血清Hcy、ACE活性與ACE基因表達的相關性。[結果]觀察隨訪3個月,排除失訪及未嚴格遵守實驗設計的患者,剩余103例患者,A組49例,B組54例,結果如下:(1)A組與B組相比血壓較前均有所下降,且A組總體血壓下降程度較B組更明顯,血清中血管緊張素轉化酶活性、Hcy水平下降幅度A組均明顯高于B組,統(tǒng)計學差異明顯(P0.05)。(2)血壓達標率和總有效率A組血壓達標率高于B組,統(tǒng)計學方面無明顯差異(P0.05);(3)H型高血壓患者中Hcy、ACE活性及ACE mRNA表達兩兩呈正相關。[結論](1)葉酸與血管緊張素轉化酶抑制劑聯(lián)合使用在H型高血壓患者中可以通過降低血清中同型半胱氨酸水平,也可能是通過影響血清中同型半胱氨酸水平進一步影響血清中血管緊張素轉化酶活性達到降低血壓幅度的目的,但是不改變血壓達標率(2)在H型高血壓患者中,隨著血清中Hcy含量的增高,ACE mRNA表達及ACE活性均增強,兩兩之間具有相關性,可以通過降低血清中Hcy水平進一步治療H型高血壓。
[Abstract]:[objective] to investigate the effect of folic acid combined with angiotensin converting enzyme inhibitor (ACE) treatment on serum angiotensin converting enzyme (ACE) activity in patients with H type hypertension. Furthermore, the mRNA expression of angiotensin converting enzyme gene and the analysis of related factors were discussed from the gene level to provide more clinical basis for the treatment of H type hypertension. [methods] 110 patients with H type hypertension were selected from the outpatient and inpatient department of the first people's Hospital of Kunming from January to October 2016. After signing the informed consent, they were divided into group A and group B according to the principle of randomization. Group A was the study group and group B was the control group, with 55 persons in each group. General data of all participants were collected including name, sex, age, body mass index (BMI), blood test data including fasting blood glucose, homocysteine, folic acid, angiotensin-converting enzyme (ACE) activity, blood test data including fasting blood glucose, homocysteine, angiotensin-converting enzyme (ACEA) activity, blood test data including fasting blood glucose, homocysteine, angiotensin-converting enzyme (angiotensin-converting enzyme) activity, Creatinine, triglyceride-triglycer@@ Adverse drug reactions and related complications. Group A was treated by folic acid 0.8 mg combined with perindopril tert butylamine tablet 4mg. Group B was treated with perindopril tert butylamine 4mg alone. Subjects who did not meet the requirements of exclusion at any time were observed and compared with the remaining patients after 3 months of treatment, the blood pressure of the two groups decreased. The changes of serum HCY concentration and serum angiotensin converting enzyme activity and the blood pressure reaching standard rate and the effective rate of lowering blood pressure after 3 months. By extracting and amplifying the total RNA of angiotensin converting enzyme (ACE), the expression of ACE gene mRNA was calculated in patients with H type hypertension, and the correlation between the activity of ACE and the expression of ACE gene was discussed. [results] after 3 months of follow-up, the patients who had lost their visits and did not strictly abide by the experimental design were excluded. The remaining 103 patients were treated with 49 patients in group A and 54 patients in group B. the results showed that the blood pressure of group A was lower than that of group B, and that of group A was lower than that of group B. The total blood pressure in group A was significantly lower than that in group B, and the decrease of serum angiotensin converting enzyme activity and Hcy level in group A was significantly higher than that in group B. There was no significant difference in blood pressure reaching standard rate and total effective rate in group A and group B, but there was no significant difference in statistics between two groups. There was a positive correlation between the activity of HcyACE and the expression of ACE mRNA in patients with H type hypertension. [conclusion] folic acid combined with angiotensin-converting enzyme inhibitor can reduce serum homocysteine level in patients with type H hypertension. It is also possible that the level of homocysteine in the serum may affect the activity of angiotensin converting enzyme in the serum to reduce the blood pressure amplitude, but it does not change the blood pressure to reach the standard rate of 2%) in patients with H type hypertension, With the increase of serum Hcy content, the expression of ACE mRNA and the activity of ACE increased, and there was a correlation between the two groups, which could be further treated by reducing the level of Hcy in the serum of patients with H type hypertension.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1

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