【作者】 刘芳；

【导师】 张鹏强；

【作者基本信息】 大连医科大学 ， 内科学， 2018， 硕士

【摘要】 目的:通过观察厄贝沙坦片和硝苯地平控释片对原发性高血压患者细胞因子白细胞介素-10(interleukin-10,IL-10)、白细胞介素-17(interleukin-17,IL-17)和免疫等指标影响,探讨厄贝沙坦片和硝苯地平控释片对原发性高血压患者炎症状态影响的机理。方法:选取2016年7月至2017年12月期间于大连大学附属新华医院心血管内科门诊就诊及住院治疗的原发性高血压患者120例,设为高血压组。随机分为厄贝沙坦组(n=60)和硝苯地平组(n=60),厄贝沙坦组采用厄贝沙坦片降压治疗,硝苯地平组采用硝苯地平控释片降压治疗;选取同期健康体检者70例,设为对照组。监测三组收缩压、舒张压、脉压差、心率等情况。三组采用酶联免疫吸附试验动态检测细胞因子IL-10水平及IL-17水平,采用流式细胞仪分别测定厄贝沙坦组、硝苯地平组在治疗前、后CD4~+、CD8~+和CD4~+/CD8~+比值免疫指标。比较高血压组患者与健康体检者的细胞因子IL-10水平、IL-17水平差异及两个治疗组患者细胞因子IL-10水平、IL-17水平的差异,观察厄贝沙坦片和硝苯地平控释片对患者细胞因子IL-10水平及IL-17水平的影响。并比较两个治疗组的免疫指标、临床疗效及药物不良反应。结果:1厄贝沙坦片和硝苯地平控释片对患者血压、心率影响:两组治疗前收缩压、舒张压、脉压差、心率比较无统计学差异(P>0.05)。治疗后,两个治疗组患者脉压差比较无统计学差异(P>0.05);厄贝沙坦组患者收缩压、舒张压显著高于硝苯地平组(P<0.05);厄贝沙坦组患者心率显著低于硝苯地平组(P<0.05)。2厄贝沙坦片和硝苯地平控释片对患者细胞因子影响:高血压组患者与对照组细胞因子水平有差异,其中细胞因子IL-10水平低于对照组(P<0.05);IL-17水平高于对照组(P<0.05);两个治疗组患者细胞因子IL-10水平及细胞因子IL-17水平比较无统计学差异(P>0.05)。治疗后,两个治疗组患者细胞因子IL-10水平,显著高于治疗前(P<0.05);两个治疗组患者细胞因子IL-17水平,显著低于治疗前(P<0.05);厄贝沙坦组患者治疗后2周、4周、6周及8周细胞因子IL-10水平,均显著高于硝苯地平组(P<0.05);厄贝沙坦组患者治疗后2周、4周、6周及8周细胞因子IL-17水平,均显著低于硝苯地平组(P<0.05)。3厄贝沙坦片和硝苯地平控释片对患者免疫指标影响:治疗前,两个治疗组免疫指标比较无统计学差异(P>0.05)。厄贝沙坦组与硝苯地平组治疗后8周,CD4~+和CD4~+/CD8~+比值,均显著低于治疗前(P<0.05);厄贝沙坦组与硝苯地平组治疗后8周CD8~+,显著高于治疗前(P<0.05);厄贝沙坦组患者治疗后8周CD4~+和CD4~+/CD8~+比值,均显著低于硝苯地平组(P<0.05);厄贝沙坦组患者治疗后8周CD8~+水平,显著高于硝苯地平组(P<0.05)。4药物的不良反应:治疗8周,厄贝沙坦组药物不良反应发生率为5.00%,与硝苯地平组的7.50%比较无统计学差异(P>0.05)。5原发性高血压患者细胞因子与血压、免疫的相关性:细胞因子IL-10水平与收缩压、舒张压、免疫水平呈显著负相关(P<0.05);细胞因子IL-17水平与收缩压、舒张压、免疫水平呈显著正相关(P<0.05)。结论:1原发性高血压患者采用厄贝沙坦片和硝苯地平控释片均能有效的控制患者血压,升高细胞因子IL-10水平及降低细胞因子IL-17水平,调节机体免疫。2厄贝沙坦片较硝苯地平控释片能更好的抑制炎性反应,调整机体免疫状态。更多还原

【Abstract】 Objective:To discuss the mechanism of Irbesartan Tablets and Nifedipine Controlled Released Tablets affecting the inflammatory status of primary hypertensive patients by observing the effects of Irbesartan Tablets and Nifedipine Controlled Released Tablets on the cytokines interleukin-10(IL-10),interleukin-17(IL-10),immune function and otherindicatorsin primary hypertensive patients.Methods:120 primary hypertensive patients treated at the cardiovascular internal medicine department of Xinhua Hospital Affiliated to Dalian University from July 2016to December 2017 were selected as the hypertension group,which were randomly divided into Irbesartan group(n=60)that took Irbesartan Tablets for antihypertensive treatment and Nifedipine group(n=60)that took Nifedipine Controlled Released Tablets for antihypertensive treatment;70 healthy controls in the corresponding period were selected as the control group.The systolic pressure,diastolic pressure,pulse pressure,heart rate and other situations of the three groups were monitored.The enzyme-linked immunosorbent assay was used to detect the cytokines IL-10 level and IL-17 level of the three groups,and the flow cytometry was used to determine CD4~+level,CD8~+level,and CD4~+/CD8~+ratio immune indicator of the Irbesartan and Nifedipine groups before and after treatment.The cytokines IL-10 level and IL-17 level in the hypertensive patients and healthy controls were compared;the cytokines IL-10level and IL-17 level of the two treatment groups were also compared,observing the effects of Irbesartan Tablets and Nifedipine Controlled Released Tablets on the cytokines IL-10 and IL-17 in the patients.The immune indicator,clinical efficiency and adverse drug reactions of the two treatment groups were compared.Results:1.The effects of Irbesartan Tablets and Nifedipine Controlled Released Tablets on blood pressure and heart rate of the patients:there was no statistic difference in the comparison of systolic pressure,diastolic pressure,pulse pressure and heart rate between the two treatment groups before and after treatment(P>0.05).After treatment,there was no statistic difference in the comparison of pulse pressure of the patients between the two treatment groups(P>0.05);the systolic pressure and diastolic pressure of the patients in the Irbesartan group were significantly higher than that in the Nifedipine group(P<0.05);the heart rate of the patients in the Irbesartan group was significantly lower than that in the Nifedipine group(P<0.05).2.The effects of Irbesartan Tablets and Nifedipine Controlled Released Tablets on the cytokines in the patients:there was difference between the cytokine levels in the patients of the hypertension group and the control group,in which the cytokine IL-10level was lower than that of the control group(P<0.05)and the cytokine IL-17 level was higher than that of the control group(P<0.05);there was no statistic difference in the comparison of the cytokines IL-10 level and IL-17 level between the two treatment groups(P>0.05).After treatment,the cytokine IL-10 level in the patients of the two treatment groups was significantly higher than that before treatment(P<0.05);the cytokine IL-17 level in the patients of the two treatment groups was significantly lower than that before treatment(P<0.05);at the second,fourth,sixth and eighth weeks after treatment,the cytokine IL-10 levels in the patients of the Irbesartan group were significantly higher than that of the Nifedipine group(P<0.05)while the cytokine IL-17levels in the patients of the Irbesartan group were significantly lower than that of the Nifedipine group(P<0.05).3.The effects of Irbesartan Tablets and Nifedipine Controlled Released Tablets on the immune indicator in the patients:before treatment,there was no statistic difference in the comparison of the immune indicator of the two treatment groups(P>0.05).At the eighth week of treatment,the CD4~+level and CD4~+/CD8~+ratio of the Irbesartan group and Nifedipine group were significantly lower than that before treatment(P<0.05)while the CD8~+level of the Irbesartan group and Nifedipine group was significantly higher than that before treatment(P<0.05).At the eighth week of treatment,the CD4~+level and CD4~+/CD8~+ratio of the Irbesartan group were significantly lower than that of the Nifedipine group(P<0.05),while the CD8~+level in the patients of the Irbesartan group was significantly higher than that of the Nifedipine group(P<0.05).4.Adverse drug reactions:8 weeks of treatment,the incidence of adverse drug reactions of the Irbesartan group was 5.00%,and there was no statistic difference comparing to 7.50%of the Nifedipine group(P>0.05).5.The correlation of the cytokines with blood pressure and immunity in primary hypertensive patients:the cytokine IL-10 level had a significantly negative correlation with systolic pressure,diastolic pressure,and immune level(P<0.05);the cytokine IL-17 level had a significantly positive correlation with systolic pressure,diastolic pressure,and immune level(P<0.05).Conclusion:1.The use of Irbesartan Tablets and Nifedipine Controlled Released Tablets in primary hypertensive patients can effectively control the blood pressure,increase the cytokine IL-10 level,decrease the cytokine IL-17 level,and regulate the body’s immunity.2.The Irbesartan Tablets can better inhibit inflammatory response and regulate the body’s immune status than Nifedipine Controlled Released Tablets.更多还原