叶酸联合血管紧张素转化酶抑制剂对H型高血压患者血管紧张素转化酶活性的影响及相关因素分析

发布时间：2018-05-30 11:30

本文选题：血管紧张素转化酶抑制剂 + 同型半胱氨酸　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]以H型高血压患者为研究对象,探究叶酸联合血管紧张素转化酶抑制剂治疗对其血清中血管紧张素转化酶活性的影响,并进一步从基因层面上探讨血管紧张素转化酶基因mRNA表达和相关因素分析,为H型高血压的治疗提供更多临床依据。[方法]选取2016年1月份至10月份昆明市第一人民医院门诊及住院部收治的H型高血压患者110例,签署知情同意书后,依据随机化原则分为A组、B组,其中A组为研究组,B组为对照组,每组均为55人。收集所有入选对象的一般资料包括姓名、性别、年龄、体重指数(body mass index,BMI);血液检测资料包括空腹血糖(fasting blood glucose,FBG)、同型半胱氨酸(homocysteine,Hcy)、叶酸、血管紧张素转化酶(angiotensin-converting enzyme,ACE)活性、肌酐(creatinine,CREA)、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C),收缩压(systolic blood pressure,SBP),舒张压(diastolic blood pressure,DBP),同时监测入选患者的肝肾功能、药物不良反应及相应并发症。A组采用叶酸0.8 mg联合ACEI代表类药物培哚普利叔丁胺片4mg治疗,B组采用培哚普利叔丁胺片4mg单独治疗,过程中电话随访,随时排外不符合要求的受试者,观察对比剩余患者经3个月治疗后两组血压下降程度、血清HCY浓度及血清血管紧张素转化酶活性的改变及3个月后患者血压达标率和降压有效率。并通过对血管紧张素转化酶总RNA提取及扩增,计算H型高血压患者中ACE基因mRNA表达含量,探讨血清Hcy、ACE活性与ACE基因表达的相关性。[结果]观察随访3个月,排除失访及未严格遵守实验设计的患者,剩余103例患者,A组49例,B组54例,结果如下:(1)A组与B组相比血压较前均有所下降,且A组总体血压下降程度较B组更明显,血清中血管紧张素转化酶活性、Hcy水平下降幅度A组均明显高于B组,统计学差异明显(P0.05)。(2)血压达标率和总有效率A组血压达标率高于B组,统计学方面无明显差异(P0.05);(3)H型高血压患者中Hcy、ACE活性及ACE mRNA表达两两呈正相关。[结论](1)叶酸与血管紧张素转化酶抑制剂联合使用在H型高血压患者中可以通过降低血清中同型半胱氨酸水平,也可能是通过影响血清中同型半胱氨酸水平进一步影响血清中血管紧张素转化酶活性达到降低血压幅度的目的,但是不改变血压达标率(2)在H型高血压患者中,随着血清中Hcy含量的增高,ACE mRNA表达及ACE活性均增强,两两之间具有相关性,可以通过降低血清中Hcy水平进一步治疗H型高血压。
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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