劉左玲　劉衍宇　凌云等

[摘要] 目的 阿托伐他汀鈣聯(lián)合硝笨地平緩釋片治療輕中度高血壓合并心臟病的臨床療效及其對(duì)肝腎功能的影響。 方法 隨機(jī)將150例輕中度高血壓合并左室肥厚患者分為兩組，對(duì)照組給予硝苯地平緩釋片治療，治療組在此基礎(chǔ)上加用阿托伐他汀鈣治療。治療18個(gè)月后，比較兩組血壓、左室后壁厚度（LVPW）和室間隔厚度（IVS）及肝腎功能。 結(jié)果 兩組治療后血壓均達(dá)標(biāo)，治療組收縮壓、舒張壓下降較對(duì)照組明顯。兩組LVPW和IVS均有所改善，治療組改善更加明顯。治療組有2例患者出現(xiàn)轉(zhuǎn)氨酶升高而停用阿托伐他汀鈣，對(duì)照組無1例發(fā)生肝腎功能損害。 結(jié)論 阿托伐他汀鈣聯(lián)合硝苯地平緩釋片聯(lián)合治療輕中度高血壓合并左室肥厚患者療效更優(yōu)，且無明顯肝腎損害。

[關(guān)鍵詞] 輕中度高血壓；左室肥厚；阿托伐他汀鈣；硝笨地平緩釋片

[中圖分類號(hào)] R544.1；R589.2 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 2095-0616（2015）11-66-03

[Abstract] Objective To ivvestigate the clinical effect of Atorvastatin calcium combined with Extended Release Nifedipine Tablets in the treatment of mild to moderate hypertension complicated with heart disease its effect on liver and renal function. Methods 150 patients with mild to moderate hypertension and left ventricular hypertrophy were divided into two groups，the control group was given Extended Release Nifedipine Tablets，the treatment was given atorvastatin calcium in addition to Extended Release Nifedipine Tablets.After 18 months of treatment，The blood pressure，left ventricular posterior wall thickness（LVPW），ventricular septal thickness（IVS）and the function of liver and kidney were compared between the two groups. Results The blood pressure of the 2 groups after treatment were standard.The systolic pressure，diastolic pressure decreased more significantly in the observation group than the control group.The LVPW and IVS were improved more obviously in the observation group.2 patients in the observation group appeared elevated transaminase and then reduced after the discontinuation of atorvastatin calcium.1 case in the control group appeared liver and kidney function damage. Conclusion Atorvastatin calcium combined with extended release nifedipine tablets has good effect in the treatment of mild to moderate hypertension with left ventricular hypertrophy，and has no obvious damage of liver and kidney.

[Key words] Mild to moderate hypertension；Left ventricular hypertrophy；Atorvastatin calcium；Nitric stupid nimodipine sustained-release tablets

原發(fā)性高血壓是一種遺傳與環(huán)境因素共同作用的遺傳異質(zhì)性疾病，主要表現(xiàn)為基因表達(dá)異常和病理性的血壓升高。是中老年患者最常見的心血管疾病，也是心腦血管疾病的主要危險(xiǎn)因素之一[1]。高血壓總患病率約為30%～45%，且隨年齡增長而急劇增加[2]。左室肥厚是高血壓患者后期心血管病死亡和致殘的獨(dú)立危險(xiǎn)因素，逆轉(zhuǎn)左室肥厚能后顯著改善高血壓患者的臨床結(jié)局及預(yù)后[3]。近年來探討逆轉(zhuǎn)高血壓患者左室肥厚的藥物是高血壓治療領(lǐng)域的活躍分子。本研究順應(yīng)目前研究熱點(diǎn)，探討輕中度高血壓合并左室肥厚患者應(yīng)用阿托伐他汀鈣聯(lián)合硝笨地平緩釋片的降壓效果及對(duì)患者左室舒張末期內(nèi)徑的影響，并且統(tǒng)計(jì)其對(duì)肝腎功能的影響，為臨床治療高血壓合并左室肥厚患者提供參考。

1 資料與方法

1.1 一般資料

隨機(jī)選擇我院2012年1月～2013年6月就診的老年輕中度高血壓合并左室肥厚患者150例為研究對(duì)象，高血壓及左室肥厚診斷標(biāo)準(zhǔn)符合2010年《中國高血壓治療指南》診斷標(biāo)準(zhǔn)，血壓標(biāo)準(zhǔn)為收縮壓140～179mm Hg或（和）舒張壓90～109mm Hg。排除繼發(fā)性高血壓、血脂異常、肝腎功能不全、冠心病、腦血管病等疾病。將150例研究對(duì)象隨機(jī)分為兩組，對(duì)照組75例，平均年齡（65.3±3.6）歲，男39例，女36例。治療組75例，平均年齡（64.9±4.1）歲，男38例，女37例。兩組患者在年齡、性別構(gòu)成、體重指數(shù)、血壓（SBP、DBP、PP）、基礎(chǔ)血脂（LDL-C）、左室舒張末內(nèi)徑（LVEDd）、肝功能（ALT、AST）、腎功能（肌酐）等方面比較無統(tǒng)計(jì)學(xué)意義（P>0.05），具有可比性。見表1。endprint