不同血管紧张素受体拮抗剂对老年高血压患者血小板活性的影响

摘要

Objective:To investigate the different inhibitory effects of lorsartan,irbesartan and valsartan on platelet aggregation in elderly hypertensive patients. Methods:According to varied medication history,90 enrolled hypertensive patients over the age of 65 were divided into lorsartan (n=30),irbesartan (n=30)and valsartan (n=30)treatment group.Then,platelet aggregation rate (PAR) and plasma levels of angiotension Ⅱ (Ang Ⅱ ),COX-2 and TXB2 were determined.Human aortic endothelial cells (HAECs)were stimulated by Ang Ⅱ with or without treatment of lorsartan,irbesartan and valsartan,and the relative expression of COX-2 and TXB2 was assessed. Results:PAR was lower with the treatment of irbesartan and valsartan compared with lorsartan (12.62% ±0.74%,10.70% ± 0.70% and 17.17%±1 .44%),P <0.001 among three groups],associated with more reduced plasma levels of COX-2[(81 .04 ± 14.19)U/L,(75.00 ± 11 .14)U/L and(145.10 ±26.52)U/L,P =0.012 among three groups]and TXB2 [(1 577.00±161 .90)pg/ml,(1 324.00±121 .40)pg/ml and(2 025.00± 154.10)pg/ml,P =0.004 among three groups].Relative increased expression in HAECs of COX-2 and secretion of TXB2 stimulated by Ang Ⅱ were more significantly inhibited by irbesartan or valsartan, respectively compared with lorsartan,P < 0.01 . Conclusion:Irbesartan and valsartan may more effectively decrease platelet activity in elderly hypertensive patients by attenuating the expression of COX-2/TXB2 .%目的：探讨氯沙坦、厄贝沙坦及缬沙坦3种血管紧张素受体拮抗剂（ARB）对老年高血压患者血小板活性的影响。方法：入选年龄＞65岁、长期服用 ARB 的老年高血压患者90例，根据用药情况分成氯沙坦、厄贝沙坦、缬沙坦3个治疗组。分别测定各组血小板聚集率（PAR）、血管紧张素Ⅱ（Ang Ⅱ）、环氧化酶-2（COX-2）、血栓素 B2（TXB2）水平。比较经不同 ARB 处理的内皮细胞中，由 Ang Ⅱ诱导产生的 COX-2 mRNA 及蛋白表达量、TXB2水平。结果：氯沙坦、厄贝沙坦及缬沙坦组3组的 PAR分别为12．62％±0．74％、10．70％±0．70％和17．17％±1．44％，P ＜0．001；COX-2分别为（81．04±14．19）、（75．00±11．14）、（145．10±26．52）U／L，P ＝0．012；TXB2为（1577．00±161．90）、（1324．00±121．40）、（2025．00±154．10）pg／ml，P ＝0．004。与氯沙坦组相比，厄贝沙坦、缬沙坦组 COX-2 mRNA 及蛋白表达、TXB2水平下降更为显著，P ＜0．01。结论：厄贝沙坦、缬沙坦通过抑制 COX-2／TXB2表达，能更有效地抑制老年高血压患者的血小板活性。