目的：研究依那普利叶酸片对H型高血压左室肥厚患者心血管事件及心功能指标的影响。方法选取2012年9月至2013年9月收入我院的H型高血压左室肥厚患者100例为研究对象，分为治疗组和对照组，每组各50例。对照组口服依那普利，治疗组口服依那普利叶酸片，2组均治疗12个月。治疗前后检测患者血浆同型半胱氨酸（ Hcy）水平、心功能及左室射血分数、主要心血管事件发生率及不良反应发生情况。结果治疗前，2组患者收缩压（ SBP ）、舒张压（ DBP ）差异无统计学意义（P＞0．05），治疗后，2组SBP、DBP均显著降低（P＜0．05），且治疗组降压效果更加明显。治疗前，2组患者血浆Hcy水平比较未见统计学差异（P＞0．05），治疗后，2组血浆Hcy水平均显著降低（P＜0．05），且治疗组降低更加明显。治疗后，治疗组和对照组患者E／A值，分别由0．65±0．09和0．64±0．13上升到0．93±0．14和0．77±0．12，治疗前后，2组E／A值比较差异均有统计学意义（P＜0．05）；治疗后，与对照组相比，治疗组患者E／A值显著升高，2组相比差异具有统计学意义（P＜0.05）。治疗后，治疗组和对照组的左室射血分数（ LVEF）值分别由64．64±1．19和65．11±1．47上升到69．43±1．40和66．95±1．38，治疗前后2组LVEF差异具有统计学意义（P＜0．05）；治疗后，与对照组相比，治疗组LVEF值显著升高，2组相比差异具有统计学意义（P＜0．05）。患者随访时间2～12个月，平均随访时间（7．53±3．74）个月。随访过程中，对照组出现7例主要心血管事件，其中4例脑卒中，2例心肌梗死，1例心血管病死亡，无主要心血管事件生存率为86．0％。治疗组共发生3例主要心血管事件，其中2例脑卒中，1例心肌梗死，无主要心血管事件生存率为94．0％。与对照组比较，治疗组无主要心血管事件生存率显著提高，2组相比差异具有统计学意义（P＜0．05）。结论依那普利叶酸片降压及降低血浆Hcy、逆转左室肥厚作用更强，心血管事件发生率更低，其疗效显著强于依那普利，有效保护心脏。%Objective To investigate the effects of enalapril folic acid tablets on the cardiac function and cardiovascular events in patients with H-type hypertension .Methods One hundred cases of H -type hypertension were chosen as research subjects from the patients hospitalized in our hospital for treatment from September , 2012 to September, 2013, and were randomly divided into the treatment group and the control group , each consisting of 50 patients.The control group was given enalapril orally and the treatment group received enalapril folic acid tablets orally , all for a treatment of 12 months.Plasma homocysteine (Hcy) levels, cardiac function and left ventricular ejection fraction , major cardiovascular events and adverse reactions were detected both before and after treatment . Results Before treatment, no significant differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) could be seen in the patients of the 2 groups(P>0.05).After treatment, the DBP and SBP in the patients of the 2 groups were significantly de-creased(P>0.05), with that of the treatment group decreased more prominently .Before treatment, there was no statistical significance in the plasma Hcy levels, when comparisons were made between the 2 groups(P>0.05).However, after treatment, the plasma Hcy levels of the 2 groups were all significantly decreased (P>0.05), with that of the treatment group decreased more significantly .After treatment, the E/A values of the treatment group and the control group were increased from (0.65 ±0.09) and (0.64 ±0.13) to (0.93 ±0.14) and (0.77 ±0.12), and statistical significance could be noticed , as the E/A value before treatment was compared with that after treatment(P<0.05).After treatment, the E/A value of the treatment group was significantly increased , as compared with that of the control group , and statistical significance could be seen , when comparisons were made between the 2 groups ( P<0.05).After treatment, the LVEF values of the treatment group and the control group were increased from (64.64 ±1.19) and (65.11 ±1.47) to (69.43 ±1.40) and (66.95 ±1.38), and statistical significance could be noticed , as the LVEF value before treatment was compared with that after treatment (P<0.05).Following treatment, the LVEF value of the treatment group was signifi-cantly increased , as compared with that of the control group , and statistical significance could also be found , when comparisons were made between the 2 groups(P<0.05).The patients had medical follow-ups for as long as 2 to 12 months, with an average follow-up time of (7.53 +3.74) months.During the said follow-up time, the control group had 7 cases of cardiovascular events , of which 4 were cerebral apoplexy , 2 were myocardial infarction and 1 was cardiovascular death .Patient survival without major cardiovascular events was 86.0%.In the treatment group , there were 3 cases of major cardiovascular events , of which 2 were cerebral apoplexy , 1 was myocardial infarction .Patient survival without major cardiovascular events was 94.0%.As compared with that of the control group , the survival rate of the treatment group was significantly improved , and statistically significance could be noted , when comparisons were made between the 2 groups (P<0.05).Conclusion Enalapril folic acid tablets could more effectively reduce blood pressure , plasma Hcy and reverse left ventricular hypertrophy , and reduce incidence of cardiovascular events , and it was more superior to enalapril in the treatment efficacy , and at the same time it could effectively protect the heart .
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