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目的:观察原发性高血压患者应用苯那普利和缬沙坦前后心肌声学密度各指标的变化情况,以探讨苯那普利和缬沙坦对高血压心肌纤维化的作用。方法:共入选原发性高血压患者75例(A组),随机分为3个亚组:A1组(25例),给予苯那普利10mg/d;A2组(25例),给予缬沙坦160mg/d;A3组(25例),给予苯那普利和缬沙坦半剂量合用(苯那普利5mg/d加缬沙坦80mg/d),均治疗6个月,并设立正常对照组(B组)75例。应用超声心动图测量心肌声学密度各项值:室间隔矫正的声学强度(CAI1)和左室后壁矫正的声学强度(CAI2)及室间隔背向散射积分周期变化值(CVIB1)、左室后壁背向散射积分周期变化值(CVIB2)。结果:A组的收缩压和舒张压显著高于B组,A1、A2、A3亚组用药后的收缩压和舒张压均显著低于用药前(均P<0.01);A组的CAI1、CAI2(0.88±0.06,0.73±0.06)显著高于B组(0.66±0.19,0.54±0.06)(P<0.01),而A组的CVIB1、CVIB2(6.07±0.85),(7.00±1.15)dB显著低于B组(8.60±3.12),(11.85±3.06)dB(均P<0.05);A1和A2亚组用药后CAI1、CAI2、CVIB1、CVIB2比较均差异无统计学意义(均P>0.05);A3组用药后CAI1、CAI2显著低于A1、A2组用药后(P<0.01),而A3组用药后CVIB1、CVIB2显著高于A1、A2组用药后(P<0.01;P<0.05)。结论:心肌声学密度各参数可用于评价高血压心肌纤维化,苯那普利和缬沙坦都减轻心肌纤维化,两者合用在减轻心肌纤维化方面效果更明显。
OBJECTIVE: To observe the changes of myocardial acoustic density before and after the application of benazepril and valsartan in patients with essential hypertension to investigate the effects of benazepril and valsartan on myocardial fibrosis in hypertensive patients. Methods: A total of 75 patients with essential hypertension (group A) were randomly divided into three subgroups: group A1 (25 cases), benazepril 10 mg / day; group A2 (n = 25) The combination of benazepril and valsartan (benazepril 5 mg / d plus valsartan 80 mg / d) were given for 6 months and were normal Control group (B group) 75 cases. The values of myocardial acoustical densities were measured by echocardiography. The values of CAI1, CAI2 and CVIB1 in left ventricular posterior chamber Wall backscatter integration period variation (CVIB2). Results: The systolic and diastolic blood pressure in group A was significantly higher than that in group B, and the systolic and diastolic blood pressure in groups A1, A2 and A3 were significantly lower than those before treatment (all P <0.01); in group A, CAI1 and CAI2 (0.88 ± 0.06,0.73 ± 0.06) were significantly higher than those in group B (0.66 ± 0.19,0.54 ± 0.06) (P <0.01), while the values of CVIB1 and CVIB2 (6.07 ± 0.85) and (7.00 ± 1.15) dB in group A were significantly lower than those in group B There were no significant differences in the levels of CAI1, CAI2, CVIB1 and CVIB2 between A1 and A2 subgroups (all P> 0.05) in group B (8.60 ± 3.12) and (11.85 ± 3.06) dB In group A3, CAI1 and CAI2 were significantly lower than those in A1 and A2 groups (P <0.01). However, CVIB1 and CVIB2 in group A3 were significantly higher than those in group A1 and A2 (P <0.01; P <0.05). CONCLUSION: The parameters of myocardial acoustic density can be used to evaluate myocardial fibrosis in hypertensive patients. Both benazepril and valsartan attenuate myocardial fibrosis, and the combination of the two is more effective in reducing myocardial fibrosis.