马来酸依那普利叶酸片对MTHFR基因多态的H型高血压患者的疗效观察(1)
[摘要] 目的 观察马来酸依那普利叶酸片对MTHFR基因多态的H型高血压患者的疗效。 方法 选取我院2011年6月～2014年3月480例H型高血压患者，分为马来酸依那普利叶酸片治疗的实验观察组和其他CCB类、排钾利尿剂、ACEI或ARB等单药或联合药物治疗的对照组，检测两组患者治疗前后的收缩压、舒张压、同型半胱氨酸(Hcy)和MTHFR基因型别等指标。 结果 治疗前，两组患者收缩压，舒张压，CC、CT和TT基因型Hcy水平等比较，差异无统计学意义(P>0.05)。治疗后1、2、3个月，观察组患者收缩压，舒张压及CC、CT和TT基因型Hcy水平均显著下降，其中TT型Hcy水平下降最明显，与对照组比较，差异有统计学意义(P<0.05)。观察组组内患者在治疗后第1个月与第2个月、第2个月与第3个月比较，其收缩压，舒张压及CC、CT和TT基因型Hcy水平均有下降，差异有统计学意义(P<0.05)。 结论 马来酸依那普利叶酸片较应用其他降压药可更好地降低Hcy水平，特别是对TT基因型患者疗效显著。
[关键词] 马来酸依那普利叶酸片；同型半胱氨酸；MTHFR基因型
[中图分类号] R544.1 [文献标识码] A [文章编号] 1674-4721(2016)03(c)-0032-04
[Abstract] Objective To observe the effects of enalapril maleate-folate tablet in H type hypertension patients with MTHFR gene polymorphism. Methods 480 H type hypertension patients from June 2011 to March 2014 of our hospital were selected and were divided into experimental group that treated with enalapril maleate-folate tablet and control group that treated simply or combined with other CCB，drain potassium diuretics，ACEI or ARB.The index of systolic pressure，diastolic pressure，homocysteine and MTHFR gene in two groups before and after treatment were tested. Results Before treatment，the systolic pressure，diastolic pressure and Hcy with CC，CT and TT gene type between observation group and control group had no statistical significance(P>0.05).After treatment for 1，2 and 3 months，all of the systolic pressure，diastolic pressure and Hcy with CC，CT and TT gene type in observation group decreased obviously compared with before treatment，and the TT type decreased most，and the difference was statistical significance(P<0.05).Among patients in observation group，the systolic pressure，diastolic pressure and Hcy with CC，CT and TT gene type were decreased when compared the treatment for 1 and 2 months or 2 and 3 months，and the difference was statistical significance(P<0.05). Conclusion Enalapril maleate-folate tablet can decrease Hcy better than using other hypotensive drugs，especially for TT gene type patients，which has obvious effects.
[Key words] Enalapril maleate-folate tablet；Homocysteine；MTHFR gene type
心脑血管疾病现已跃居至国人病死原因之首，统计显示，城市年死亡率为200/10万，农村为142/10万，且仍以每年8.7%的速度升高[1-2]。心脑血管疾病患者有一半与高血压密切相关。研究显示，高血压多伴有Hcy升高，而高Hcy是缺血性心脏病及深静脉血栓发生的重要危险因素之一，是脑卒中的独立危险因素，临床上称为H型高血压[3-4]，此类患者心血管事件发生率较单纯存在高血压的患者高约5倍，较正常人高25～30倍。受环境、遗传等因素影响，国人Hcy水平较高。研究显示，高血压患者中H型高血压高达75%左右，是我国脑卒中高发的重要原因之一[5-6]。MTHFR是Hcy代谢途径中的关键酶，其编码基因的突变可影响Hcy代谢[7-8]。因此，对高血压患者MTHFR基因多态性的检测有助于对高血压患者进行分层及疗效评估。叶酸是目前有效降低Hcy的药物，0.5～5 mg的叶酸可使Hcy降低25%～33%[9-10]。本文旨在观察马来酸依那普利叶酸片对MTHFR基因多态的H型高血压患者的疗效。, 百拇医药(谢胜)
[关键词] 马来酸依那普利叶酸片；同型半胱氨酸；MTHFR基因型
[中图分类号] R544.1 [文献标识码] A [文章编号] 1674-4721(2016)03(c)-0032-04
[Abstract] Objective To observe the effects of enalapril maleate-folate tablet in H type hypertension patients with MTHFR gene polymorphism. Methods 480 H type hypertension patients from June 2011 to March 2014 of our hospital were selected and were divided into experimental group that treated with enalapril maleate-folate tablet and control group that treated simply or combined with other CCB，drain potassium diuretics，ACEI or ARB.The index of systolic pressure，diastolic pressure，homocysteine and MTHFR gene in two groups before and after treatment were tested. Results Before treatment，the systolic pressure，diastolic pressure and Hcy with CC，CT and TT gene type between observation group and control group had no statistical significance(P>0.05).After treatment for 1，2 and 3 months，all of the systolic pressure，diastolic pressure and Hcy with CC，CT and TT gene type in observation group decreased obviously compared with before treatment，and the TT type decreased most，and the difference was statistical significance(P<0.05).Among patients in observation group，the systolic pressure，diastolic pressure and Hcy with CC，CT and TT gene type were decreased when compared the treatment for 1 and 2 months or 2 and 3 months，and the difference was statistical significance(P<0.05). Conclusion Enalapril maleate-folate tablet can decrease Hcy better than using other hypotensive drugs，especially for TT gene type patients，which has obvious effects.
[Key words] Enalapril maleate-folate tablet；Homocysteine；MTHFR gene type
心脑血管疾病现已跃居至国人病死原因之首，统计显示，城市年死亡率为200/10万，农村为142/10万，且仍以每年8.7%的速度升高[1-2]。心脑血管疾病患者有一半与高血压密切相关。研究显示，高血压多伴有Hcy升高，而高Hcy是缺血性心脏病及深静脉血栓发生的重要危险因素之一，是脑卒中的独立危险因素，临床上称为H型高血压[3-4]，此类患者心血管事件发生率较单纯存在高血压的患者高约5倍，较正常人高25～30倍。受环境、遗传等因素影响，国人Hcy水平较高。研究显示，高血压患者中H型高血压高达75%左右，是我国脑卒中高发的重要原因之一[5-6]。MTHFR是Hcy代谢途径中的关键酶，其编码基因的突变可影响Hcy代谢[7-8]。因此，对高血压患者MTHFR基因多态性的检测有助于对高血压患者进行分层及疗效评估。叶酸是目前有效降低Hcy的药物，0.5～5 mg的叶酸可使Hcy降低25%～33%[9-10]。本文旨在观察马来酸依那普利叶酸片对MTHFR基因多态的H型高血压患者的疗效。, 百拇医药(谢胜)