摘要目的 探讨以非洛地平为基础的联合降压方案在降压达标的基础上对中青年女性高血压病患者性功能的影响.方法 研究采用前瞻性、随机、平行、对照、开放、固定治疗的设计方案.选择2008-2009年在兰州大学第二医院就诊的中青年(年龄18～60岁)女性1～2级高血压病患者99例,随机分2组:非洛地平缓释片5 mg/d+厄贝沙坦片150 mg/d(F+I组,n=49),非洛地平缓释片5 mg/d+琥珀酸美托洛尔片47.5 mg/d(F+M组,n=50).以美国女性性功能指数量表(FSFI)进行问卷调查并检测血清雌二醇和总睾酮的含量,随访24周.FSFI总分以小于25.5定义为性功能障碍,以血压＜140/90 mm Hg(1 mm Hg=0.133 kPa)为达标.结果 F+I组与F+M组治疗第4、8、12周和第24周血压达标率分别为42.9%比62.0%、89.8%比90.0%、93.9%比94.0%和98.0%比96.0%,两组之间比较差异均无统计学意义(均P＞0.05).绝经前与绝经后患者在F+I组治疗后性欲指数和性唤起功能指数均升高(P分别＜0.05或＜0.01),雌二醇水平升高[绝经前:(50.3±37.4)pg/L比(54.4±10.8)pg/L,绝经后:(18.4±2.9)pg/L比(20.2±3.1)pg/L,P分别＜0.05或＜0.01],睾酮水平下降[绝经前:(722.8±277.1)ng/L比(650.0±156.0)ng/L,绝经后:(841.2±279.3)ng/L比(761.9±197.8)ng/L,P分别＜0.05或＜0.01];在F+M组治疗后性欲指数和阴道湿润度指数均降低(均P＜0.01),雌二醇水平降低[绝经前:(57.4±9.7)pg/L比(51.1±12.1)pg/L,绝经后:(19.8±2.3)pg/L比(17.8±3.3)pg/L,均P＜0.01],睾酮水平升高[绝经前:(775.6±217.8)ng/L比(886.0±186.4)ng/L,绝经后:(812.5±311.3)ng/L比(914.4±300.2)ng/L,均P＜0.01].高血压组FSFI总分与年龄和收缩压水平均呈负相关(均P＜0.01).结论 非洛地平缓释片与厄贝沙坦片或琥珀酸美托洛尔片联合降压达标率相同.前者可以在一定程度改善女性高血压病患者性功能.

abstractsObjective To compare the effects between felodipine plus irbesartan and felodipine plus metoprolol regimen on blood pressure and the sexual function in young and middle-aged hypertensive women. Methods In this prospective, randomized, parallelized, controlled and fixed combined therapy trial, 99 female patients(aged 18 to 60)with grade 1 and grade 2 hypertension(BP ≥ 140/90 mm Hg and ＜ 179/109 mm Hg, 1 mm Hg =0.133 kPa)were assigned to felodipine 5 mg q.d + irbesartan 150 mg q.d(F + I group, n = 49)and felodipine 5 mg q. d + metoprolol 47.5 mg q. d(F + M group, n = 50)group. Target blood pressure was ＜ 140/90 mm Hg. The female sexual function index(FSFI)questionnaire, levels of serum estradiol and testosterone were assessed. Female sexual dysfunction was defined as a FSFI score of less than 25.5. Patients were followed up for 24 weeks. Results The rate of achieving blood pressure goal between 2 groups was similar at the 4th, 8th, 12th and 24th weeks respectively (42.9% vs. 62.0% at 4th week, 89.8% vs. 90.0% at 8th week, 93.9% vs. 94.0% at 12th week,98.0% vs. 96.0% at 24th week, P ＞ 0.05). Compared to baseline, scores for the items related to"desire" and "arousal" were significantly improved(P ＜ 0.05), the level of the serum estradiol was significantly elevated[(50.3 ± 37.4)pg/L vs.(54.4 ± 10.8)pg/L before menopause,(18.4 ± 2.9)pg/L vs.(20.2 ±3.1)pg/L after menopause, P ＜0.05]and the level of the serum testosterone was significantly decreased[(722.8 ± 277.1)ng/L vs.(650.0 ± 156.0)ng/L before menopause,(841.2 ± 279.3)ng/L vs.(761.9 ± 197.8)ng/L after menopause, P ＜ 0.05]in the F + I group, while scores for the items related to" sexual desire" and "lubrication" were statistically reduced(P ＜ 0.01), the concentration of the serum estradiol was significantly reduced[(57.4 ± 9.7)pg/L vs.(51.1 ± 12.1)pg/L before menopause,(19.8±2.3)pg/L vs.(17.8 ± 3.3)pg/L after menopause, P ＜0.01]and the level of the serum testosterone was significantly increased[(775.6 ± 217.8)ng/L vs.(886.0 ± 186.4)ng/L before menopause,(812.5 ± 311.3)ng/L vs.(914.4 ± 300.2)ng/L after menopause, P＜0.01]in the F+M group. FSFI score was negatively correlated with age and systolic blood pressure levels. Conclusion felodipine plus irbesartan or metoprolol for 24 weeks equally reduced blood pressure and the former regimen is superior to the latter on sexual function improvement in this patient cohort.