马来酸依那普利叶酸片用于脑卒中二级预防的临床研究

目的观察马来酸依那普利叶酸片(简称依叶)对脑卒中的二级预防是否优于马来酸依那普利片。方法筛选250例伴有"H型高血压"的脑卒中患者,随机分为两组予以口服依叶片或依那普利片1年。试验前后分别测量患者的血压、心率、血清同型半胱氨酸(HCY)、叶酸、维生素B12、颈动脉内膜中层厚度(CIMT),治疗期间连续随访记录不良反应。随访结束时比较两组脑卒中再发率、死亡发生率有无差异。结果依叶组和依那普利组治疗后均可显著降低血压(P<0.05),两组血压控制率分别为81%和79%,组间比较差异无统计学意义。两组降低HCY水平分别为47%、5.7%,组间比较差异有统计学意义(P<0.05)。治疗后组间比较CIMT差异有统计学意义(P<0.05)。相关性分析显示HCY与CIMT呈正相关(r=0.365,P<0.05)。终点事件比较两组脑卒中再发率和死亡率差异均有统计学意义(P<0.05),心血管发生率差异无统计学意义。结论依叶降压和降HCY水平效果显著,同时可以有效减缓动脉粥样硬化进展,稳定CIMT。依叶可以进一步降低脑卒中再发率及死亡率。依叶对缺血性脑卒中的二级预防作用显著优于依那普利片。

Clinical research of enalapril maleate tablets folic acid for secondary prevention of ischemic stroke

Objective To observe enalapril maleate folic acid tablets(short for Yiye) prevent stroke recurrence whether superior to enalapril tablets or not.Methods 250 cases of stroke with "H-type hypertension" were devided randomly into Yiye group or enalapril maleate tablets group uninterrupted treatment for 1 year.Blood pressure,heart rate,serum homocysteine(HCY),folate,vitamin B12,carotid intimamedia thickness,before and after the test two groups of patients were measured in.Continuous follow-up to record adverse reactions.The different of stroke recurrence rate and the death between the two groups was compared at the end.Results Yiye group and the enalapril group were significantly lower blood pressure after treatment(P<0.05).Two sets of blood pressure control rates were 81% and 79%,there was no significant difference between the two groups(P>0.05).Yiye group and enalapril group could reduce HCY levels 47%,5.7% respectively,the difference between the two groups was statistically significant(P<0.05).CIMT enalapril group was significantly higher than that in Yiye group,the difference was statistically significant(P<0.05).Correlation analysis showed that HCY was significantly associated with CIMT(r=0.365,P<0.05).Compared with stroke recurrence and mortality rates end point was statistically significant(P<0.05) but cardiovascular rate was no statistically significant.Conclusion Yiye can lower HCY level and blood pressure significantly,and slow down effectively the progress of atherosclerosis,stabl CIMT.Yiye may be further reduced stroke recurrence rate and mortality.Prevention of secondary prevention of stroke Yiye is significantly better than that of enalapril tablets.