四联疗法治疗高血压合并脑梗死的疗效及其对血清PI3K/AKT信号通路的影响

张秀娟; 周婉; 张群卫; 朱捷

doi:10.16766/j.cnki.issn.1674-4152.004401

四联疗法治疗高血压合并脑梗死的疗效及其对血清PI3K/AKT信号通路的影响

doi: 10.16766/j.cnki.issn.1674-4152.004401

张秀娟¹,
周婉²,
张群卫³,
朱捷^1, ,

1.
中国人民解放军联勤保障部队第九〇一医院药剂科，安徽合肥 230001
2.
中国人民解放军联勤保障部队第九〇一医院采购管理科
3.
中国科学技术大学附属第一医院内分泌科，安徽合肥 230001

基金项目:

安徽省高校自然科学研究项目 2023AH040398

详细信息

通讯作者:
朱捷，E-mail：zzyy105@sina.com

中图分类号: R544.1 R743.2
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- 文章访问数: 15
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- 被引次数: 0
出版历程
- 收稿日期: 2025-08-11
- 网络出版日期: 2026-06-02

Curative effect of quadruple therapy on hypertension complicated with cerebral infarction and its effect on serum PI3K/Akt signaling pathway

1.
Department of Pharmacy, the 901st Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army, Hefei, Anhui 230001, China

摘要

摘要: 目的观察四联疗法治疗高血压合并脑梗死的临床效果，检测治疗前后血清磷脂酰肌醇3-激酶/蛋白激酶B(PI3K/AKT)通路表达变化，探讨其潜在作用机制。方法选取2021年1月—2024年10月中国人民解放军联勤保障部队第九〇一医院收治的158例高血压合并脑梗死患者为研究对象，采用随机数表法将其分为对照组和观察组，各79例。对照组采用阿司匹林肠溶片、硫酸氢氯吡格雷片、阿托伐他汀钙片三联疗法，观察组接受联用苯磺酸氨氯地平片的四联疗法。比较2组临床疗效，治疗前后的收缩压(SBP)、舒张压(DBP)、美国国立卫生研究院卒中量表(NIHSS)评分、脑卒中专用生活质量量表(SS-QOL)评分，血清PI3K、AKT蛋白表达水平及不良反应。结果观察组的临床总有效率为91.14%(72/79)，显著高于对照组的70.89%(56/79，χ²=15.003，P=0.001)。治疗1、2、3个月后，2组SBP、DBP、NIHSS评分均降低，SS-QOL评分升高，血清PI3K、AKT蛋白水平下降(P＜0.05)，观察组改善更明显，且时间和组别对结果有影响(P＜0.05)。观察组不良反应总发生率(6/79, 7.59%)和对照组(11/79, 13.92%)比较差异无统计学意义(χ²=2.377，P=0.677)。结论四联疗法治疗高血压合并脑梗死不仅能有效控制血压，改善神经功能和生活质量，还能调节血清PI3K/AKT信号通路，且不增加不良反应。
- 高血压合并脑梗死 /
- 四联疗法 /
- 临床疗效 /
- 血清PI3K/AKT信号通路
Abstract: Objective To observe the clinical efficacy of quadruple therapy in the treatment of hypertension complicated with cerebral infarction, detect the expression changes of the serum phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway before and after treatment, and explore its potential mechanism of action. Methods A total of 158 patients with hypertension and cerebral infarction were selected from the 901st Hospital of the Joint Service Support Force of the Chinese People's Liberation Army from January 2021 to October 2024 as the study samples. The patients were divided into the control group and the observation group, with 79 patients each by random number table. The control group received triple therapy with aspirin enteric coated tablets, clopidogrel hydrogen sulfate tablets, and atorvastatin calcium tablets, while the observation group received quadruple therapy with amlodipine besylate tablets. The clinical efficacy of the two groups was compared, including systolic blood pressure (SBP), diastolic blood pressure (DBP), National Institutes of Health stroke scale (NIHSS) score, stroke specific quality of life scale (SS-QOL) score, serum PI3K and AKT protein expression levels, and incidence of adverse reactions after treatment. Results The total clinical effective rate of the observation group was 91.14% (72/79), which was significantly higher than that of the control group (70.89%, 56/79, χ²=15.003, P=0.001). After 1, 2, and 3 months of treatment, SBP, DBP, and NIHSS scores decreased in both groups, while SS-QOL scores increased, and serum levels of PI3K and AKT proteins decreased (P < 0.05), with more pronounced improvements observed in the observation group. Both time and group factors had significant effects on the outcomes (P < 0.05). The total incidence of adverse reactions in the observation group was 7.59% (6/79), while in the control group it was 13.92% (11/79), with no statistically significant difference (χ²=2.377, P=0.677). Conclusion Quadruple therapy is effective in the treatment of hypertension complicated with cerebral infarction. It can not only effectively control blood pressure, improve neurological function and quality of life, but also play a therapeutic role by regulating serum PI3K/Akt signaling pathway, without increasing the incidence of adverse reactions.
- Hypertension complicated with cerebral infarction /
- Quadruple therapy /
- Clinical efficacy /
- Serum PI3K/Akt signaling pathway

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表 1 2组高血压合并脑梗死患者一般资料比较

Table 1. General information comparison of two groups of hypertensive patients with cerebral infarction

组别	例数	年龄(x±s，岁)	性别(男/女，例)	高血压病程(x±s，年)	BMI(x±s)	脑梗死部位(基底核区/脑叶/丘脑/小脑，例)	脑梗死部位直径(x±s，cm)	糖尿病[例(%)]	冠心病[例(%)]	心律失常[例(%)]
对照组	79	65.06±6.20	42/37	9.62±1.79	23.31±1.07	36/20/16/7	2.54±0.83	23(29.11)	14(17.72)	16(20.25)
观察组	79	64.81±6.47	39/40	9.41±1.80	23.23±1.77	34/22/18/5	2.51±0.84	21(26.58)	15(18.99)	15(18.99)
统计量		0.251^a	0.228^b	0.753^a	0.334^a	0.603^b	0.226^a	0.126^b	0.042^b	0.040^b
P值		0.802	0.633	0.453	0.739	0.896	0.822	0.723	0.837	0.841
注：^a为t值，^b为χ²值。

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表 2 2组高血压合并脑梗死患者总有效率比较[例(%)]

Table 2. Clinical efficacy comparison of two groups of hypertensive patients with cerebral infarction [case (%)]

组别	例数	痊愈	显效	有效	无效	总有效
对照组	79	18(22.78)	23(29.11)	15(18.99)	23(29.11)	56(70.89)
观察组	79	30(37.97)	26(32.91)	16(20.25)	7(8.86)	72(91.14)
注：2组总有效率比较，χ²=15.003，P=0.001。

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表 3 2组高血压合并脑梗死患者治疗前后血压指标比较(x±s, mmHg)

Table 3. Comparison of blood pressure parameters before and after treatment between two groups of hypertensive patients with cerebral infarction (x±s, mmHg)

组别	例数	SBP				F值	P值
组别	例数	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	79	147.84±5.41	140.22±5.05^a	135.56±4.80^ab	130.59±5.07^abc	164.054	＜0.001
观察组	79	148.03±5.09	136.84±4.78^a	128.39±4.42^ab	122.25±4.67^abc	437.700	＜0.001
t值		0.227	4.318	9.769	10.759
P值		0.821	＜0.001	＜0.001	＜0.001

组别	例数	DBP				F值	P值
组别	例数	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	79	105.54±5.24	100.39±4.61^a	95.48±4.73^ab	92.39±4.52^abc	114.639	＜0.001
观察组	79	105.39±5.09	97.99±4.33^a	90.53±3.76^ab	84.70±3.38^abc	363.939	＜0.001
t值		0.185	3.378	7.281	12.133
P值		0.854	0.001	＜0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同组治疗1个月比较，^bP＜0.05；与同组治疗2个月比较，^cP＜0.05。

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表 4 2组高血压合并脑梗死患者治疗前后NIHSS及SS-QOL评分比较(x±s，分)

Table 4. Comparison of NIHSS and SS-QOL scores before and after treatment between two groups of hypertensive patients with cerebral infarction(x±s, points)

组别	例数	NIHSS				F值	P值
组别	例数	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	79	36.68±6.07	32.32±5.22^a	27.32±5.21^ab	22.35±4.18^abc	111.618	＜0.001
观察组	79	36.97±6.03	30.25±4.95^a	23.60±4.13^ab	17.67±3.16^abc	249.663	＜0.001
t值		0.302	2.549	4.957	7.937
P值		0.763	0.012	＜0.001	＜0.001

组别	例数	SS-QOL				F值	P值
组别	例数	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	79	78.87±9.05	96.85±8.11^a	105.70±6.68^ab	138.78±8.04^abc	774.901	＜0.001
观察组	79	78.34±9.07	102.38±7.93^a	126.42±5.93^ab	167.35±6.54^abc	2 041.958	＜0.001
t值		0.369	4.336	20.621	24.500
P值		0.713	＜0.001	＜0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同组治疗1个月比较，^bP＜0.05；与同组治疗2个月比较，^cP＜0.05。

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表 5 2组高血压合并脑梗死患者治疗前后血清PI3K、AKT蛋白表达水平比较(x±s)

Table 5. Comparison of serum PI3K and AKT protein expression levels before and after treatment between two groups of hypertensive patients with cerebral infarction(x±s)

组别	例数	PI3K				F值	P值
组别	例数	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	79	5.72±1.46	4.96±1.16^a	4.52±1.13^ab	4.01±1.09^abc	27.820	＜0.001
观察组	79	5.90±1.36	4.58±1.15^a	3.96±1.04^ab	3.26±1.16^abc	70.723	＜0.001
t值		0.782	2.064	3.229	4.241
P值		0.435	0.041	0.002	＜0.001

组别	例数	AKT				F值	P值
组别	例数	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	79	5.42±0.70	5.19±0.80^a	5.00±0.78^ab	4.00±0.62^abc	58.250	＜0.001
观察组	79	5.48±0.70	4.94±0.92^a	4.55±0.73^ab	3.31±0.57^abc	121.110	＜0.001
t值		0.490	1.801	3.726	7.259
P值		0.625	0.044	＜0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同组治疗1个月比较，^bP＜0.05；与同组治疗2个月比较，^cP＜0.05。

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表 6 2组高血压合并脑梗死患者不良反应发生率比较[例(%)]

Table 6. Comparison of the incidence of adverse reactions between two groups of hypertensive patients with cerebral infarction [case (%)]

组别	例数	恶心呕吐	过敏反应	出血倾向	肝功能异常	总发生
对照组	79	3(3.80)	3(3.80)	2(2.53)	3(3.80)	11(13.92)
观察组	79	2(2.53)	1(1.27)	2(2.53)	1(1.27)	6(7.59)
注：2组不良反应总发生率比较，χ²=2.377，P=0.677。

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参考文献(18)

[1]	WEI Y F, XIE X W, PAN Y S, et al. Early vs delayed antihypertensive treatment in acute single subcortical infarction: a secondary analysis of the CATIS-2 randomized clinical trial[J]. JAMA Netw Open, 2024, 7(8): e2430820. DOI: 10.1001/jamanetworkopen.2024.30820.
[2]	LIU W C, ZHENG Z J, FENG Z, et al. Risk of acute cerebral infarction in patients with hypertension based on high-resolution MRI[J]. Quant Imaging Med Surg, 2025, 15(4): 3000-3010. doi: 10.21037/qims-24-2106
[3]	师晶晶, 鲍婕妤, 张静, 等. 大脑中动脉狭窄粥样硬化斑块特征对因动脉狭窄所致脑梗死的影响[J]. 中华全科医学, 2024, 22(6): 962-965, 1072. doi: 10.16766/j.cnki.issn.1674-4152.003544 SHI J J, BAO J Y, ZHANG J, et al. Effect of atherosclerotic plaque characteristics of middle cerebral artery on cerebral infarction caused by arterial stenosis[J]. Chinese Journal of General Practice, 2024, 22(6): 962-965, 1072. doi: 10.16766/j.cnki.issn.1674-4152.003544
[4]	赖娟, 王勉, 邓霖, 等. 参松养心胶囊联合阿托伐他汀钙片对超高危急性冠状动脉综合征患者的临床疗效[J]. 中成药, 2024, 46(7): 2240-2243. LAI J, WANG M, DENG L, et al. Clinical effects of Shensong Yangxin Capsules combined with Atorvastatin Calcium Tablets on patients with ultra? high risk of acute coronary syndrome[J]. Chinese Traditional Patent Medicine, 2024, 46(7): 2240-2243.
[5]	张龙飞, 党肖萍, 陈思文. 血栓通软胶囊联合苯磺酸氨氯地平治疗高血压合并脑梗死的疗效及对血压, 血液流变学的影响[J]. 临床和实验医学杂志, 2024, 23(12): 1249-1253. ZHANG L F, DANG X P, CHEN S W. Therapeutic effect of Xueshuantong soft capsules combined with amlodipine besylate on hypertension complicated with cerebral infarction and its impact on blood pressure, hemorheology[J]. Journal of Clinical and Experimental Medicine, 2024, 23(12): 1249-1253.
[6]	中国老年医学学会高血压分会, 北京高血压防治协会, 国家老年疾病临床医学研究中心. 中国老年高血压管理指南2023[J]. 中华高血压杂志, 2023, 31(6): 508-538. Hypertension Branch of Chinese Geriatrics Society, Beijing Hypertension Prevention and Treatment Association, National Clinical Research Center for Geriatric Diseases (Chinese People's Liberation Army General Hospital, Xuanwu Hospital of Capital Medical University), et al. Chinese Guideline for the Management of Hypertension in the Elderly 2023[J]. Chinese Journal of Hypertension, 2023, 31(6): 508-538.
[7]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南2023[J]. 中华神经科杂志, 2024, 57(6): 523-559. Chinese Neurological Association, Cerebrovascular Disease Section of Chinese Neurological Association. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2023[J]. Chinese Journal of Neurology, 2024, 57(6): 523-559.
[8]	陈玉涛, 刘秀君, 张瑞燕, 等. 替罗非班联合尤瑞克林对急性进展性脑梗死患者有显著疗效[J]. 内科急危重症杂志, 2024, 30(1): 39-42. CHEN Y T, LIU X J, ZHANG R Y, et al. Significant effect of tirofiban combined with ureklin in the treatment of patients with APCI[J]. Journal of Critical Care In Internal Medicine, 2024, 30(1): 39-42.
[9]	王春琼. 针灸+康复训练在中风偏瘫患者中的应用效果及NIHSS评分影响分析[J]. 检验医学与临床, 2024, 21(2): 160-163. WANG C Q. Analyze the application effect of acupuncture+rehabilitation training in stroke hemiplegia patients and the influence of NIHSS score[J]. Laboratory Medicine and Clinic, 2024, 21(2): 160-163.
[10]	林思思, 刘天翔, 黄冬和, 等. 互动性健康教育对围绝经期脑卒中患者生活质量肢体功能及深静脉血栓发生的影响[J]. 中国妇幼保健, 2024, 39(7): 1340-1343. LIN S S, LIU T X, HUANG D H, et al. Impact of interactive health education on quality of life, limb function, and deep vein thrombosis incidence in perimenopausal stroke patients[J]. Maternal and Child Health Care of China, 2024, 39(7): 1340-1343.
[11]	陈怡然, 冯秀芝, 宋囡, 等. 基于络病理论探讨血脂异常合并脑卒中[J]. 中华中医药学刊, 2024, 42(3): 152-155. CHEN Y R, FENG X Z, SONG N, et al. Discussion on Dyslipidemia Combined with Cerbral Apoplexy on Theory of Collateral Disease[J]. Chinese Archives of Traditional Chinese Medicine, 2024, 42(3): 152-155.
[12]	尹絮, 宋雨, 吴东彬. 厄贝沙坦联合苯磺酸氨氯地平对难治性高血压患者降压效果、动脉粥样硬化及负性情绪的影响[J]. 实用心脑肺血管病杂志, 2023, 31(5): 112-115. YIN X, SONG Y, WU D B. Effect of irbesartan combined with amlodipine besylate on antihypertensive effect, atherosclerosis and negative emotion in patients with refractory hypertension[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2023, 31(5): 112-115.
[13]	HUANG F, WANG C, YAN Y X, et al. Efficacy of atorvastatin calcium on clinical manifestations and serum inflammatory markers in elderly patients with hypertension[J]. Am J Transl Res, 2024, 16(10): 6008-6017. doi: 10.62347/OKXS1649
[14]	WU Z X, WANG M M, MAO Q X, et al. Assessment of the impact of combining butylphthalide and atorvastatin on neurological function, quality of life and vascular endothelial function in individuals diagnosed with acute cerebral infarction[J]. Pak J Pharm Sci, 2024, 37(5): 1003-1010.
[15]	王鸿权. 苯磺酸氨氯地平片联合酒石酸美托洛尔片对老年晨峰高血压合并冠心病患者血压变异性、血压晨峰现象的影响[J]. 检验医学与临床, 2024, 21(3): 363-367. WANG H Q. Effect of amlodipine besylate tablets combined with metoprolol tartrate tablets on blood pressure variability and blood pressure morning peak phenomenon in elderly patients with morning peak hypertension combined with coronary heart disease[J]. Laboratory Medicine and Clinic, 2024, 21(3): 363-367.
[16]	司书晗, 宋世禛, 解雪云, 等. 电针调控miR-142-5p和ADAMTS1/PI3K/AKT通路促进缺血性脑卒中大鼠血管新生的机制研究[J]. 针刺研究, 2024, 49(8): 787-796. SI S H, SONG S Z, XIE X Y, et al. Electroacupuncture promotes angiogenesis by regulating miR-142-5p and activating ADAMTS1/PI3K/AKT pathway in ischemic stroke rats[J]. Acupuncture Research, 2024, 49(8): 787-796.
[17]	RAO R, GAN L L, ZHAO R, et al. Electroacupuncture alleviates cerebral ischemia injury by regulating PI3K/AKT/NF-κB signaling in microglia of ischemic stroke rats[J]. Neuroreport, 2025, 36(1): 22-30. doi: 10.1097/WNR.0000000000002115
[18]	周丽娜, 辛欢, 杨敏. 加味红龙夏海汤联合苯磺酸氨氯地平治疗对高血压合并颈动脉斑块患者血压、血脂及内皮功能的影响[J]. 四川中医, 2023, 41(1): 96-100. ZHOU L N, XIN H, YANG M. Influence of modified honglong xiahai decoction combined with amlodipine besylate tablet on blood pressure, blood lipid and endothelial function for patients of hypertension with carotid plaque[J]. Journal of Sichuan of Traditional Chinese Medicine, 2023, 41(1): 96-100.