乐卡地平治疗老年高血压及其对循环造血祖细胞的作用

摘要

目的 探讨乐卡地平治疗老年高血压患者的疗效和对外周血造血祖细胞数量的影响.方法 入选上海交通大学医学院附属仁济医院老年科2014年1-12月门诊就诊的高血压患者61例,数字抽签随机分为乐卡地平组32例,服用盐酸乐卡地平5～10 mg/d;对照组29例,降压药物根据患者情况采用噻嗪类利尿剂和(或)β受体阻滞剂,观察12周,目标血压为＜ 140/90 mmHg(1mmHg=0.133 kPa).用药前后检测患者血脂、血糖、肝肾功能及红细胞沉降率等实验室检查指标,采用流式细胞分析的方法检测外周造血祖细胞数量(以外周血CD34+ CD45dim细胞的数量外周血100 000个单核细胞的百分比进行计数). 结果 乐卡地平组用药后血压下降,患者血压均达标.血压下降幅度对照组与乐卡地平组比较差异无统计学意义(P＞0.05).乐卡地平治疗12周后CD34+ CD45dim细胞数升高(0.022±0.003)％与(0.034±0.028)％ (P＜0.05);与对照组比较,乐卡地平组CD34+ CD45dim细胞数量有上升趋势,但差异无统计学意义(P＞0.05).以CD34+ CD45dim数量为自变量,行多元逐步线性回归分析结果显示,收缩压与CD34+ CD45dim细胞数量呈负相关(B=-1.794,t=-23.04,P＜0.01). 结论 老年高血压患者外周血祖细胞数量与收缩压呈负相关.乐卡地平增加外周血祖细胞数量,且不依赖于其降压作用.%Objective To investigate the effect of Lecarnidipine on hypertension and circulation hematopoietic progenitor cells (HPCs) count in elderly patients.Methods A total of 61 elderly patients with hypertension were selected in Renji Hospital geriatric hypertension clinic from January 2014 to August 2014.Patients were randomly divided into two groups:Lercanidipine treatment group (n=32,Lercanidipine hydrochloride 5-10 mg/day),the control group (n=29,thiazide diuretics and / or beta blockers according to patient's condition).Patients were observed for 12 weeks,and the target blood pressure level was ＜140/90 mmHg (1 mmHg=0.133 kPa).Blood lipids and glucose levels,liver and kidney function and erythrocyte sedimentation rate (ESR) were determined before and after treatment.The quantity of circulation HPCs (the percentage of CD34+ CD45dim in peripheral blood in 100000 mononuclear cells) was detected by flow cytometry analysis.Results Blood pressure in Lercanidipine treatment group was decreased after the treatment (P＜0.01),and patients reached the target blood pressure.There was no difference in the decrease of blood pressure level between the two groups (P＞0.05).The number of CD34+ CD45dim cells was increased after 12 weeks of Lecarnidipine treatment [(0.022 + 0.003)％ vs.(0.034 + 0.028)％,P＜0.05].Compared with the control group,the number of CD34+ CD45dim cells in lercanidipine group had a rising trend,but it had no statistical difference (P＞0.05).Taking the number of CD34+ CD45dim as the independent variables,the multiple stepwise linear regression analysis showed that the number of CD34+ CD45dim cells was negatively correlated to systolic pressure.Conclusions The number of circulation HPCs is negatively correlated with systolic pressure in the elderly.Lercanidipine can increase the number of circulation HPCs,and does not rely on its antihypertensive effect.