强化降脂对肾动脉粥样硬化性高血压患者的临床观察

发布时间：2018-07-03 03:17

本文选题：肾动脉粥样硬化 + 肾动脉狭窄性高血压　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：动脉粥样硬化性肾动脉狭窄所致的肾性高血压为继发性高血压的常见原因，肾动脉粥样硬化为全身动脉粥样硬化的一部分。本文旨在观察抗动脉硬化治疗对此类高血压患者肾动脉狭窄程度的控制、相关动脉粥样硬化炎症因子的改变及对肾脏的保护作用。方法：本研究主要是从炎症因子水平探讨应用他汀类药物强化降脂治疗后1年后，肾动脉狭窄的变化、相关动脉粥样硬化炎症因子以及肾功能的改变。从2011年7月至2013年6月在本院心血管内科、神经内科、肾病内科住院治疗的老年高血压患者中行肾动脉彩超检查筛选肾动脉狭窄患者，入选28人。常规给予降压治疗，血压最好控制达标（140/90mmHg）,如无禁忌，尽可能应用ACEI或ARB类降压药物。给予入选患者他汀类降脂（立普妥10-60mg）治疗，疗程1年。服用1、3、6、12个月后分别测血脂、肌酐、MMP-2、MMP-9、CRP、ox-LDL，1、6、12个月后测肝功，12个月时复查肾动脉彩超（于入选时选择同一检查方法，便于以同一标准评价）。每次复查时根据患者的LDL-C水平，调整立普妥用量至LDL-C水平降至2.6mmol/L以下或立普妥用量达到60mg/每天（非药物说明中的最大剂量），调整剂量后1个月需进行肝功检查。如服用他汀类药物出现轻度转氨酶升高时可进一步观察，如升高3倍以上减量，如不能耐受加量则应用调整用药前的剂量继续治疗。如减量至（立普妥10mg/）每天,肝功仍升高3倍以上则停药退组，并给与保肝药物治疗。应用酶联免疫吸附法（ELISA法），检测动脉粥样硬化相关因子MMP-2、MMP-9、CRP、ox-LDL血清水平，并进行统计学分析。结果： 1、28例患者应用阿托伐他汀（立普妥）12个月后，LDL与OX-LDL均下降；服药12月后完成肾动脉彩超随访的19例患者，LDL的降低与肾动脉收缩期最大血流速度（PSV）、肾动脉和腹主动脉最大血流速度比（RAR）的降低采用pearson线性相关分析（R值分别为0.288，0.061；P值分别为0.023,0.048），，结果显示LDL的降低与PSV、RAR的降低呈正相关；OX-LDL的降低与PSV、RAR的降低采用spearman秩相关（R值分别为0.250，0.121；P值分别为0.032,0.026），结果显示OX-LDL的降低与PSV、RAR的降低呈正相关。提示随着时间的强化降脂时间的延长，肾动脉的血流速度有所降低。 2、根据入组患者0个月时肾动脉彩超结果，（1）应用肾动脉血流参数PSV及RAR将其分为三组：第一组为：狭窄程度50%；第二组为：50%≤狭窄程度＜60%；第三组为：狭窄程度≥60%，三组患者进行比较，患者血清MMP-2、MMP-9、CRP水平差异均无统计学意义（P0.05）；（2）通过采集病史，根据患者是否曾行冠状动脉造影检查明确诊断为冠心病，将入组患者分为冠心病组和非冠心病组，两组患者进行比较，血清MMP-2、MMP-9、CRP水平差异均无统计学意义（P0.05）。 3、根据入组28例患者0个月时肌酐浓度值将患者分为基础肾功能正常组和基础肾功能异常组，两组患者的eGFR值随着用药时间的延长均有所下降，各组内患者eGFR浓度值在0、1、3、6、,12个月之间做比较，亦具有统计学差异（P0.05）。 4、28例患者0、1、3、6、12个月生化指标（胆固醇、甘油三酯）及炎性因子（MMP-2、MMP-9、CRP、OX-LDL）均随着用药时间的延长有所下降，以上指标在0、1、3、6、12个月时浓度的差异均具有统计学差异（P0.05）。 5、比较28例患者0、1、6、12个月时肝功能指标，即谷丙转氨酶（ALT)、谷草转氨酶（AST)、肌酸激酶（CK)、肌酸激酶同工酶（CK-MB)的水平，随着用药时间的延长，以上反应肝功能的指标在0、1、6、12个月时浓度的差异无统计学差异（P0.05）。结论：强化他汀类药物降脂治疗不仅对肾动脉粥样硬化性狭窄有所控制而且对肾功能具有保护作用、安全性良好。
[Abstract]:Objective:
Renal hypertension caused by atherosclerotic renal artery stenosis is a common cause of secondary hypertension. Renal atherosclerosis is a part of systemic atherosclerosis. The purpose of this study is to observe the control of the degree of renal artery stenosis by anti arteriosclerosis treatment and the changes of inflammatory factors associated with atherosclerosis. And the protection of the kidney.
Method:
This study focuses on the changes in renal artery stenosis, related to atherosclerotic inflammatory factors and changes in renal function after 1 years of intensive lipid lowering treatment with statin drugs, from the July 2011 to June 2013 in the elderly hypertensive patients in the Department of cardiovascular medicine, neurology and nephrology. The renal artery color Doppler ultrasonography was used to select 28 patients with renal artery stenosis. The blood pressure was best controlled by the routine treatment. The blood pressure was best controlled by the standard (140/90mmHg). If no taboo, ACEI or ARB antihypertensive drugs were used. The statin lipid lowering (Lipitor 10-60mg) was given to the selected patients for 1 years. After 1,3,6,12 months, the blood lipid, creatinine, MMP- were measured respectively. 2, MMP-9, CRP, ox-LDL, 1,6,12 months after the test of liver function, 12 months after the reexamination of the renal artery color ultrasound (select the same examination method for the same criteria for evaluation). At the time of each reexamination, according to the patient's LDL-C level, the dosage of Lipitor to LDL-C level below 2.6mmol/L or the dosage of Lipitor to 60mg/ daily (non drug description) The maximum dose), 1 months after the adjustment of the dose, the liver function should be examined. If a statin is used for a mild transaminase increase, it can be further observed, such as an increase of more than 3 times, if the dosage is not tolerated, and the dosage before the use of the drug is continued. For example, the liver function still rises more than 3 times a day and the liver function is still raised more than 3 times. The serum levels of atherosclerotic related factors MMP-2, MMP-9, CRP and ox-LDL were detected by enzyme linked immunosorbent assay (ELISA), and the serum levels were analyzed with statistical analysis.
Result:
12 months after the use of atorvastatin (Lipitor) in 1,28 patients, both LDL and OX-LDL decreased, and 19 patients completed renal artery color Doppler follow-up after December. The decrease of LDL and the maximum velocity of renal artery systolic blood flow (PSV), and the decrease of the maximum blood flow velocity ratio (RAR) of the renal and abdominal aorta (RAR) were analyzed by Pearson linear correlation analysis (R value was 0, respectively). .288,0.061; P values are 0.023,0.048 respectively), and the results show that the decrease of LDL is positively correlated with the decrease of PSV and RAR; the decrease of OX-LDL and the decrease of PSV and RAR are associated with Spearman rank (R value is 0.250,0.121, respectively). The blood flow velocity of renal artery decreased with the prolongation of lipid time.
2, according to the results of renal artery color Doppler ultrasound at 0 months in the group, (1) the renal artery blood flow parameters PSV and RAR were divided into three groups: the first group was: the degree of stenosis was 50%; the second group was 50% or less of the stenosis degree < 60%; the third group was: the degree of stenosis was more than 60%, and the patients in the three group were compared. The difference of serum MMP-2, MMP-9, and CRP levels was not statistically significant. Learning significance (P0.05); (2) by collecting the medical history, according to whether the patients had been diagnosed as coronary artery coronary artery angiography, the patients were divided into coronary heart disease group and non coronary heart disease group, and the two groups were compared, the difference of serum MMP-2, MMP-9, and CRP level had no systematic significance (P0.05).
3, according to the concentration of creatinine at 0 months in the group of 28 patients, the patients were divided into normal group of basic renal function and abnormal renal function group. The eGFR value of the two groups decreased with the prolongation of the time of drug use. The concentration of eGFR in the patients in each group was 0,1,3,6, and the comparison between 12 months was also statistically significant (P0.05).
The 0,1,3,6,12 months biochemical indexes (cholesterol, triglyceride) and inflammatory factors (MMP-2, MMP-9, CRP, OX-LDL) in 4,28 patients were all decreased with the prolongation of the time of drug use, and the difference of the above indexes at 0,1,3,6,12 months was statistically significant (P0.05).
5, to compare the liver function indexes of 28 patients at 0,1,6,12 months, that is, the level of alanine aminotransferase (ALT), cereal transaminase (AST), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB). With the prolongation of the time of drug use, there is no statistical difference in the concentration of liver function at 0,1,6,12 months (P0.05).
Conclusion:
Intensive statin lipid-lowering therapy can not only control renal atherosclerotic stenosis but also protect renal function and safety.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692;R544.1

【参考文献】