【摘要】 目的 探讨缬沙坦和氨氯地平对高血压病患者血浆apelin-12浓度的影响、两者的对比及其临床意义。方法 轻、中度高血压病患者组110例，随机分为缬沙坦治疗组58例，氨氯地平治疗组52例，治疗16周，酶联免疫法测定治疗前后血浆apelin-12浓度，健康体检者50例作为对照。结果 高血压患者血浆apelin-12降低与正常人比较，差异有统计学意义，缬沙坦治疗后血浆apelin-12浓度升高程度高于氨氯地平组。结论 缬沙坦降压较氨氯地平更能升高血浆apelin-12水平。
【关键词】 高血压病；apelin-12；缬沙坦；氨氯地平
comparative study to effect of valsartan andamlodipine on plasma apelin-12 in patients with essential hypertension
wang shi-xun, wang juan-ling, liu tong-xiang.
department of cardiology, weifang people’s hospital.weifang 261041, china
【abstract】 objective to study the effect of valsartan and amlodipine on plasma apelin-12 in patients with essential hypertension. methods the 110 mild and moderate hypertension patients were divided randomly into 2 groups, 58 patients were treated in valsartan, 52patients were treated in amlodipine. 50 healthy people physical examinded were control group. all the cases were detected apelin-12. after 16 weeks’ anti-hypertensine lowering with valsartan and amlodipine for eh group, the above item was detected again.results the plasma apelin-12 level after treatment of valsartan and amlodipine was significantly higher than that of treatment before. the plasma apelin-12 level after treatment of valsartan was significantly higher than that of treatment of amlodipine. conclusion valsartan increase plasma apelin-12 more than amlodipine.
【key words】 hypertension; apelin-12; valsartan; amlodipine
apelin是近年新发现的心血管活性肽，是孤儿g蛋白偶联受体的内源性配体［1］，广泛存在于心血管组织中。wwW.11665.Com属于血管紧张素肾素系统，apelin具有扩张血管、降低血压和正性肌力作用［2］。但药物对血浆apelin的影响研究较少，特别arb类药物选择性影响肾素血管紧张素系统，是否比其他降压药物更能升高血浆apelin的水平，本文就此展开讨论。
1 资料与方法
1.1 一般资料 2009年4月至2009年10月在潍坊市人民医院心内二科门诊就诊的轻、中度高血压病患者110例，其中男60例，女 50例，年龄34～72岁，均（48.0 ±7.2）岁，诊断以2005年
3 讨论
国内外多种体内外实验研究表：apelin作为一种心血管活性肽参与血压的调节。tatemoto［3］等用10nmol/kg的apelin-12和apelin-13使平均动脉压map分别减少26 mm hg和 11 mm hg。lee［4］等报道：给wistar大鼠静脉注射apelin后，血压立即出现显著改变，收缩压下降（10.0±1.9）mm hg，舒张压下降（13.0±2.8）mm hg，这种效应可持续一段时间，且对心率影响甚微。
apelin通过与受体结合，通过调节血管内径［5］，调节血管升压素的分泌［6］，刺激no使一氧化氮合成增加［7］，受体的吞包作用［8］，调节肌球蛋白轻链磷酸化及降低camp水平来发挥降压作用。
氨氯地平主要通过阻断钙离子通道来降压，缬沙坦通过拮抗血管紧张素受体来发挥降压作用，两者控制高血压患者血压下降后均降低了患者血浆apelin的水平，本身apelin水平的下降亦能进一步降低血压，apelin是 apj的天然配体，一种新发现的具有重要生物学作用的心血管活性多肽、属于ras体系新的组分，广泛分布于心脏及其周围血管系统。arb类药物替米沙坦降压降低血浆apelin已有报道［9］，且apelin的水平与平均动脉压呈负相关，本研究发现缬沙坦较氨氯地平更能升高患者的apelin水平，考虑可能缬沙坦，而缬沙坦为arb类药物，为ras系统的抑制剂，本身apelin属于ras系统的一部分，具体缬沙坦通过以上何种手段来升高患者的apelin水平有待于进一步研究证实。
参考文献
［1］ tatemoto k,hosovam,habata y,et al. isolation and characterization of a novel endogenous peptide ligand for the human apj receptor. biochem biophysres commun,1998,251(2):471-476.
［2］ de facom,delucal,onori n, et al. apelin expression in normal human tissues. in vivo,2002，16(5):333-336.
［3］ tatemoto k, takayama k, zoumx, et al. the novelpeptide apelin lowers blood pressure via a nitric oxide-dependent mechanism. regul pept,2001，99（2-3）:87-92.
［4］ leedk,chengr,nguyen t, et al. characterization of apelin, the ligand for the apj recepter. neurochem, 2000，74(3):34-41.
［5］ kidoya h, uenom, yamada y, et al. spatialand temporal role of the apelin/apj system in the caliber size regulation of blood vessels during angiogenesis. embo j,2008，27(3):522-534.
［6］ azizim, iturrioz x, blancharda, et al. reciprocal regulation of plasma apelin and vasopressin byosmotic stimuli. j am socnephrol,2008，13(6):422-432.
［7］ ishida j, hashimoto t. regulatory roles for apj a seven trasmembrane receptor related to angiotension-type i receper in blood pressuer in vivo. j b iol chem, 2004，279(26):274-279.
［8］ iturrio zx, eimessari s,demotan, et al. functional dissociation between apelin receptor signaling and endocytosis:implications for the effectsof apelin on arterialblood pressure. archmal,2007,100(8):704-708.
［9］ 吴哲兵,余静,李光迪,等. 替米沙坦对高血压病患者血浆apelin-12水平的影响. 临床荟萃, 2006，21(5):16-18.
