缬沙坦和吲哒啪胺对高血压病患者细胞因子影响的对比研究

目的:比较吲达帕胺和缬沙坦治疗对高血压病患者外周血中细胞因子单核细胞趋化因子-1(MCP-1)、巨噬细胞炎性蛋白1α(MIP-1α)、可溶性P选择素(sP-selectin)、非对称二甲基精氨酸(ADMA)、血管紧张素Ⅱ(AngⅡ)和6-酮-PGF1α(6-keto-PGF1α)的影响。方法:选取我院门诊健康体检者20例和41例原发性高血压患者,将41例高血压患者随机分为吲哒啪胺组(20例)和缬沙坦组(21例),分别予吲哒啪胺(商品名钠催离)1.5mg/d和缬沙坦(商品名代文)80mg/d治疗4周,治疗前和治疗4周后抽血检测MCP-1,MIP-1α,sP-selectin,ADMA,AngⅡ和6-keto-PGF1α含量。结果:同正常血压组相比,高血压病患者外周血中MCP-1,MIP-1α,sP-selectin,ADMA浓度显著增加。吲哒啪胺组治疗前后MCP-1,MIP-1α和sP-selectin浓度无明显变化;而缬沙坦治疗4周后,MCP-1,MIP-1α和sP-selectin浓度与治疗前相比均显著下降分别为(19.16±3.11)pg/mLvs(16.08±2.67)pg/mL,P<0.05;(27.74±8.36)pg/mLvs(17.64±7.59)pg/mL,P<0.05;(2.67±3.18)pg/mLvs(6.15±2.94)pg/mL,P<0.01。吲达帕胺和缬沙坦治疗后,ADMA浓度均下降分别为(1.35±0.74)μmol/Lvs(0.98±0.56)μmol/L,P<0.05;(1.31±0.68)μmol/Lvs(0.71±0.52)μmol/L,P<0.01,而6-keto-PGF1α浓度增加,但在缬沙坦组增高更加显著分别为(61.96±20.81)pg/mLvs(96.72±25.89)pg/mL,P<0.05;(63.25±16.92)pg/mLvs(143.22±43.45)pg/mL,P<0.01。两组治疗前后AngⅡ无显著变化。结论:轻中度高血压病患者外周血中细胞因子MCP-1,MIP-1α,sP-selectin和ADMA的浓度增加;缬沙坦和吲哒啪胺具有相似的降压疗效,同时还可降低上述细胞因子水平。

Effects of valsartan and indapamide on plasma cytokines in essential hypertension

OBJECTIVE: investigate and compare the effect of valsartan and indapamide on inflammatory cytokines in hypertension. METHODS: Forty-one untreated patients with mild to moderate hypertension and 20 age and sex-matched normotensives were enrolled in this study. Hypertensives were treated with indapamide 1.5 mg/d (n=20) or valsartan 80 mg/d (n=21) for 4 weeks, and blood samples for determining monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1 (MIP-1alpha), sP-selectin, asymmetric dimethylarginin (ADMA), angiotensin II (Ang II), and 6-keto-PGF1alpha were collected before the treatment and 4 weeks after the treatment. RESULTS: Hypertensives exhibited significantly higher blood pressure, as well as elevated plasma levels of MCP-1, MIP-1alpha, sP-selectin and serum level of ADMA compared with the normotensives. Nevertheless, there was no significant difference in serum 6-keto-PGF1alpha and Ang II between the hypertensives and the normotensives. After the treatment with indapamide or valsartan for 4 weeks, both the systolic and diastolic blood pressures, though still higher than those of the normotensives, decreased markedly. After the treatment with indapamide for 4 weeks, MCP-1, MIP-1alpha and sP-selectin slightly decreased, but not statistically significant (P>0.05). Those cytokines decreased significantly after being treated with valsartan for 4 weeks (19.16+/-3.11) pg/mL vs (16.08+/-2.67) pg/mL, P<0.05; (27.74+/-8.36) pg/mL vs (17.64+/-7.59) pg/mL, P<0.05; (2.67+/-3.18) pg/mL vs (6.15+/-2.94) pg/mL, P<0.01]. In the 2 treatment groups, 6-keto-PGF1alpha markedly increased (61.96+/-20.81) pg/mL vs (96.72+/-25.89) pg/mL, P<0.05; (63.25+/-16.92) pg/mL vs (143.22+/-43.45) pg/mL, P<0.01]; ADMA decreased significantly (1.35+/-0.74) pg/mL vs (0.98+/-0.56) micromol/L, P<0.05; (1.31+/-0.68) pg/mL vs (0.71+/-0.52) micromol/L, P<0.01]. Though Ang II slightly increased, no statistical significance was found (P>0.05). CONCLUSION: The levels of MCP-1, MIP-1alpha, sP-selectin and ADMA were elevated in mild to moderate hypertensives. Valsartan and indapamide have similar blood pressure lowering effect. Valasartan exerts more significant effect on cytokines than indapamide does.