H型高血压颈动脉粥样硬化及依那普利叶酸片干预效果及其机制研究

目的 了解H型高血压患者Hcy 水平与颈动脉粥样硬化、血管炎症之间的相关性，探讨依那普利叶酸片对动脉粥样硬化的干预效果及其机制。方法 400例高血压患者中依据纳入标准,抽取120例患者随机分为对照组与治疗组各60例，测定Hcy、颈动脉粥样斑块及颈总动脉平均内膜中层厚度(IMT),计算斑块crouse积分。对照组常规予以依那普利片10mg/日降压，观察组选用依那普利叶酸片10mg/0.8mg/日，其它治疗包括：常规使用抗血小板、稳定斑块等对症处理，在两组间基本一致。治疗随访1年后复测上述实验室及器械检查指标。结果 Hcy水平与颈动脉粥样硬化及血管炎症反应指标成正相关，Hcy越高， IMT值越大，Crouse积分越高，反映血管炎症的Hs-CRP越高，说明两者相关性越高。依那普利叶酸片对H型高血压患者的干预效果更佳。两组患者治疗后的收缩压（SBP）及舒张压（DBP）与治疗前比较均有明显下降；治疗后两组Hcy比较，治疗组的Hcy明显低于对照组，差异有统计学意义(P＜0.05)。结论 Hcy水平是导致颈动脉粥样硬化的重要因素，Hcy参与血管炎症反应，Hcy越高，血管炎症反应越显著，动脉粥样硬化越明显。依那普利叶酸片与依那普利比较，在降压、降低Hcy水平同时，对颈动脉粥样硬化的进展能起到明显的抑制作用。

Study on H-type hypertension combined with carotid atherosclerosis and the intervention effect of enalapril maleate and folic acid tablets and its mechanisms

Objective: To investigate the correlation of Hcy level in H-type hypertension patients with carotid atherosclerosis and vascular inflammation, and to explore the intervention effect of enalapril maleate and folic acid tablets on atherosclerosis and its mechanisms. Methods: According to inclusion criteria, 120 patients were selected from 400 hypertensive patients, and randomly divided into control group and treatment group, with 60 patients in each group. Hcy, carotid atherosclerotic plaque and common carotid artery intima-media thickness (IMT) were measured, and Crouse score of plaque was calculated. The control group was routinely treated with enalapril maleate tablets (10 mg/day) for anti-hypertension while the treatment group received enalapril maleate and folic acid tablets (10mg/0.8mg/day); other treatments included routine antiplatelet application, plaque stabilization and other symptomatic treatments, which were basically consistent between the two groups. One year after treatment and follow-up, laboratory and equipment indexes mentioned above were retested. Results: Hcy level was positively correlated with the indexes of carotid atherosclerosis and vascular inflammation response; the higher the Hcy level, the higher the IMT value, the higher the Crouse score, and the higher the Hs-CRP that reflected vascular inflammation, suggesting a higher correlation. The intervention effect of enalapril maleate and folic acid tablets on H-type hypertension patients was superior. After the treatment, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both group were decreased significantly as compared with their levels before the treatment; and comparison in Hcy showed an obviously lower Hcy level in the treatment group than the control group, showing a statistically significant difference (P < 0.05). Conclusion: Hcy level is an important factor leading to carotid atherosclerosis, and Hcy participates in vascular inflammation response. To be more specific, the higher the Hcy level is, the more significant the vascular inflammation response is and the more obvious the atherosclerosis is. Compared with enalapril maleate tablets, enalapril maleate and folic acid tablets have an evidently inhibitory effect on the progression of carotid atherosclerosis in addition to anti-hypertension and reducing Hcy level.