氯沙坦联合螺内酯对腹膜透析患者残余肾功能及腹膜功能的影响
发布时间：2019-06-08 11:50
【摘要】：背景：残余肾功能和腹膜功能是影响腹膜透析患者生存率和技术生存率的重要因素。。肾素-血管紧张素-醛固酮系统激活参与肾脏病进展以及腹膜结构和功能的改变,其中血管紧张素Ⅱ、醛固酮是重要的作用因素。血管紧张素受体拮抗剂对于腹膜透析患者残余肾功能和腹膜功能的保护作用已经得到研究证实。然而长期应用血管紧张素受体拮抗剂时,醛固酮水平不能保持稳定持续的降低,即出现“醛固酮逃逸”现象,提示醛固酮受体拮抗剂的加入可能发挥有益的保护作用。 目的：观察血管紧张素受体拮抗剂氯沙坦、醛固酮拮抗剂螺内酯单用及二者联用对腹膜透析患者残余肾功能及腹膜功能的影响,对比干预肾素-血管紧张素-醛固酮系统不同环节的作用差异,探索延缓腹膜透析患者残余肾功能下降,保护腹膜功能的新方案,改善腹膜透析患者预后。 方法：以我院2010年3月至2013年3月规律行腹膜透析的终末期肾病患者作为研究对象,收集患者年龄、性别、透析龄、腹膜透析前和腹膜透析过程中各阶段的相关资料。选取其中符合纳入研究条件的60例维持性腹膜透析患者,将他们随机分为氯沙坦组、螺内酯组、联用组及对照组。氯沙坦组予以氯沙坦100mg/d口服,螺内酯组予以螺内酯20mg/d口服,联用组同时予氯沙坦100mg/d及螺内酯20mg/d,对照组予除ACEI/ARB及螺内酯以外的其他降压药物,维持患者血压目标值≤140/90mmHg,观察时间为6个月。所有患者定期(每3个月)记录血压、体重、有无不良反应等一般情况；检测24小时尿量、腹透超滤量,血肌酐、尿素氮,24小时尿肌酐、尿尿素氮、24小时腹透液肌酐、尿素氮,血电解质、血白蛋白、前白蛋白、血清总胆固醇、甘油三酯等实验室指标；进行腹膜平衡实验,评估腹膜转运功能,分析残余肾功能的变化情况。 结果： 1.对照组在研究第3个月、第6个月时的RRF值较研究开始时下降,研究开始时为(3.61±0.46) ml/min/1.732,研究第3个月为(3.11±0.68)ml/min/1.732,研究第6个月为(2.57±0.43)ml/min/1.732,差异具有统计学意义(P=0.0000),其他各组RRF值在三个时间点差异均无显著性(P0.05)；研究第6个月时对照组RRF值较其他三组低,对照组为(2.57±0.43)ml/min/1.732,氯沙坦组为(3.90±1.11)ml/min/1.732,螺内酯组为(3.24±0.66) ml/min/1.732,联用组为(3.32±0.66) ml/min/1.732,差异具有统计学意义(P=0.001),其他时间点四组间差异均无显著性(P0.05)。 2.对照组在研究第3个月、第6个月时的PET值较研究开始时升高,研究开始时为0.57±0.10,研究第3个月为0.64±0.06,研究第6个月为0.69±0.07,差异具有统计学意义(P=0.002),其他各组PET值在三个时间点差异均无显著性(P0.05)；研究第6个月时氯沙坦组、联用组较对照组PET值低,氯沙坦组为0.63±0.08,联用组为0.62±0.07,对照组为0.69±0.07,差异具有统计学意义(P=0.036),其他时间点四组间差异均无显著性(P0.05)。 3.对照组在研究第3个月、第6个月时的24小时尿量较研究开始时下降,研究开始时为(725.00±187.69)ml,研究第3个月为(625.83±150.482)ml,研究第6个月为(405.00±102.74)ml,差异具有统计学意义(P=0.000),其他各组24小时尿量在三个时间点差异均无显著性(P0.05)；研究第6个月时对照组24小时尿量较氯沙坦组、螺内酯组、联用组低,对照组为(405.00±102.74)ml,氯沙坦组为(686.27±263.41)ml,螺内酯组为(711.54±302.87)ml,联用组为(603.85±233.15)m1,差异具有统计学意义(P=0.012),其他时间点四组间差异均无显著性(P0.05)。 4.每组在各个时间点24小时超滤量差异均无统计学意义(P0.05)；三个时间点各组之间24小时超滤量差异均无统计学意义(P0.05)。 结论： 1.随着透析时间的延长,维持性腹膜透析患者的残余肾功能、尿量呈逐渐下降趋势,腹膜溶质转运率逐渐升高。 2.血管紧张素受体拮抗剂氯沙坦可延缓腹膜透析患者残余肾功能下降,保护腹膜功能。 3.醛固酮受体拮抗剂螺内酯可延缓残余肾功能下降,并可能在保护腹膜功能中发挥一定作用。 4.短期联用血管紧张素受体拮抗剂及醛固酮受体拮抗剂对于腹膜透析患者残余肾功能和腹膜功能保护作用无明显协同效应。
[Abstract]:Background: Residual renal function and peritoneal function are an important factor in the survival and technical survival of patients with peritoneal dialysis. The renin-angiotensin-aldosterone system is active in the progression of renal disease and changes in the structure and function of the peritoneum, of which angiotensin II and aldosterone are important factors. The protective effects of angiotensin receptor antagonists on the residual renal function and peritoneal function in peritoneal dialysis patients have been studied. However, when the angiotensin receptor antagonist is used for a long time, the level of aldosterone is not stable and sustained, i.e., there is a "aldosterone escape" phenomenon, and it is suggested that the addition of the aldosterone receptor antagonist may play a beneficial protective role. Objective: To observe the effects of losartan and aldosterone antagonist spironolactone on the residual renal function and the peritoneal function of peritoneal dialysis patients. To explore a new method to delay the decrease of the residual renal function in the peritoneal dialysis patients and to protect the peritoneal function, and to improve the pre-treatment of the peritoneal dialysis patients. Methods: Patients with end-stage renal disease undergoing peritoneal dialysis in our hospital from March 2010 to March 2013 were used as the subject of study to collect the phases of the patient's age, sex, dialysis age, pre-peritoneal dialysis and peritoneal dialysis. To select 60 maintenance peritoneal dialysis patients in which the study conditions were met, and they were randomly divided into the losartan group, the spironolactone group, the combination group and the combination group. In the control group, the losartan group was given losartan for 100 mg/ day, and the spironolactone group was administered with spironolactone 20 mg/ d. The combination group was given losartan 100 mg/ d and spironolactone 20 mg/ d, and the control group received other blood pressure-lowering drugs other than ACEI/ ARB and spironolactone, and the blood pressure target value of the patient was maintained at 140/90 mmHg, and the observation time was 6 months. All patients regularly (every 3 months) record the general conditions of blood pressure, body weight, and adverse reaction, etc.; detect the urine volume of 24 hours, the ultrafiltration volume of the abdominal penetration, the blood myocaria, the urea nitrogen, the 24-hour urine myography, the urine urea nitrogen, the 24-hour liquid-permeable myostatin, the urea nitrogen, the blood electrolyte, the blood, The laboratory indexes such as albumin, prealbumin, total serum cholesterol, triglyceride and other laboratory indexes were performed; the peritoneal balance experiment was performed to assess the function of the peritoneal transport and to analyze the change of the residual renal function the situation of chemical engineering Results:1. The RRF value of the control group decreased at the beginning of the study at the third month and the 6th month, and at the beginning of the study (3.61 (0.46) ml/ min/ 1.732, the third month was (3.11-0.68) ml/ min/ 1.732, and the study was (2.57-0.43) ml/ min/ 1.732 for the sixth month (P = There was no significant difference in the RRF of the other groups at three time points (P0.05); the RRF of the control group was lower in the control group at 6 months, the control group was (2.57-0.43) ml/ min/ 1.732, the losartan group (3.90-1.11) ml/ min/ 1.732, the conspironolactone group (3.24-0.66) ml/ min/ 1.732, the combination group (3.32-0.66) ml/ mi N/ 1.732, the difference had statistical significance (P = 0.001), and there was no significant difference between the four groups at other time points. (P0.05).2. In the control group, the PET value at the first 6 months of the study increased at the beginning of the study, 0.57 to 0.10 at the beginning of the study, 0.64 to 0.06 in the third month, 0.69 to 0.07 in the 6-month study, and the difference was of statistical significance. (P = 0.002), there was no significant difference between the other groups of PET (P = 0.002) and the other groups in the three time points (P0.05); in the first 6 months, the content of the losartan group, the combination group and the control group were low, the losartan group was 0.63-0.08, the combined group was 0.62-0.07, the control group was 0.69-0.07, and the difference was of statistical significance. (P = 0.036), no difference between four groups of other time points The urine volume of the control group decreased at the beginning of the study at the third month and the 6th month, and at the beginning of the study (725.00 to 187.69) ml, the third month was (625.83, 150.482) ml, and the study was (405.00 to 102.74) ml for the sixth month and the difference was statistically significant. The significance (P = 0.000) and other groups of 24-hour urine volume had no significant difference in the three time points (P0.05); in the control group at 6 months, the urine volume of the control group was lower than that of the losartan group and the spironolactone group, the combination group was low, the control group was (405.00-102.74) ml, and the losartan group (686.2 7 (263.41) ml, the spironolactone group (711.54-302.87) ml, the combination group (603.85-233.15) ml, the difference had statistical significance (P = 0.012), and the difference between the four groups of other time points There was no significant difference (P0.05).4. There was no significant difference in the amount of ultrafiltration (P0.05). No statistics Conclusion:1. With the prolongation of the dialysis time, the residual renal function and the urine volume of the patients with maintenance peritoneal dialysis are presented. Gradually decreasing, the rate of peritoneal solute transport is increasing gradually.2. Losartan of the angiotensin receptor antagonist can delay the abdomen. 3. Aldosterone receptor antagonist spironolactone can delay the residual renal function. 4. Short-term combination of angiotensin receptor antagonists and aldosterone receptor antagonists for peritoneal dialysis
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5
本文编号：2495261
[Abstract]:Background: Residual renal function and peritoneal function are an important factor in the survival and technical survival of patients with peritoneal dialysis. The renin-angiotensin-aldosterone system is active in the progression of renal disease and changes in the structure and function of the peritoneum, of which angiotensin II and aldosterone are important factors. The protective effects of angiotensin receptor antagonists on the residual renal function and peritoneal function in peritoneal dialysis patients have been studied. However, when the angiotensin receptor antagonist is used for a long time, the level of aldosterone is not stable and sustained, i.e., there is a "aldosterone escape" phenomenon, and it is suggested that the addition of the aldosterone receptor antagonist may play a beneficial protective role. Objective: To observe the effects of losartan and aldosterone antagonist spironolactone on the residual renal function and the peritoneal function of peritoneal dialysis patients. To explore a new method to delay the decrease of the residual renal function in the peritoneal dialysis patients and to protect the peritoneal function, and to improve the pre-treatment of the peritoneal dialysis patients. Methods: Patients with end-stage renal disease undergoing peritoneal dialysis in our hospital from March 2010 to March 2013 were used as the subject of study to collect the phases of the patient's age, sex, dialysis age, pre-peritoneal dialysis and peritoneal dialysis. To select 60 maintenance peritoneal dialysis patients in which the study conditions were met, and they were randomly divided into the losartan group, the spironolactone group, the combination group and the combination group. In the control group, the losartan group was given losartan for 100 mg/ day, and the spironolactone group was administered with spironolactone 20 mg/ d. The combination group was given losartan 100 mg/ d and spironolactone 20 mg/ d, and the control group received other blood pressure-lowering drugs other than ACEI/ ARB and spironolactone, and the blood pressure target value of the patient was maintained at 140/90 mmHg, and the observation time was 6 months. All patients regularly (every 3 months) record the general conditions of blood pressure, body weight, and adverse reaction, etc.; detect the urine volume of 24 hours, the ultrafiltration volume of the abdominal penetration, the blood myocaria, the urea nitrogen, the 24-hour urine myography, the urine urea nitrogen, the 24-hour liquid-permeable myostatin, the urea nitrogen, the blood electrolyte, the blood, The laboratory indexes such as albumin, prealbumin, total serum cholesterol, triglyceride and other laboratory indexes were performed; the peritoneal balance experiment was performed to assess the function of the peritoneal transport and to analyze the change of the residual renal function the situation of chemical engineering Results:1. The RRF value of the control group decreased at the beginning of the study at the third month and the 6th month, and at the beginning of the study (3.61 (0.46) ml/ min/ 1.732, the third month was (3.11-0.68) ml/ min/ 1.732, and the study was (2.57-0.43) ml/ min/ 1.732 for the sixth month (P = There was no significant difference in the RRF of the other groups at three time points (P0.05); the RRF of the control group was lower in the control group at 6 months, the control group was (2.57-0.43) ml/ min/ 1.732, the losartan group (3.90-1.11) ml/ min/ 1.732, the conspironolactone group (3.24-0.66) ml/ min/ 1.732, the combination group (3.32-0.66) ml/ mi N/ 1.732, the difference had statistical significance (P = 0.001), and there was no significant difference between the four groups at other time points. (P0.05).2. In the control group, the PET value at the first 6 months of the study increased at the beginning of the study, 0.57 to 0.10 at the beginning of the study, 0.64 to 0.06 in the third month, 0.69 to 0.07 in the 6-month study, and the difference was of statistical significance. (P = 0.002), there was no significant difference between the other groups of PET (P = 0.002) and the other groups in the three time points (P0.05); in the first 6 months, the content of the losartan group, the combination group and the control group were low, the losartan group was 0.63-0.08, the combined group was 0.62-0.07, the control group was 0.69-0.07, and the difference was of statistical significance. (P = 0.036), no difference between four groups of other time points The urine volume of the control group decreased at the beginning of the study at the third month and the 6th month, and at the beginning of the study (725.00 to 187.69) ml, the third month was (625.83, 150.482) ml, and the study was (405.00 to 102.74) ml for the sixth month and the difference was statistically significant. The significance (P = 0.000) and other groups of 24-hour urine volume had no significant difference in the three time points (P0.05); in the control group at 6 months, the urine volume of the control group was lower than that of the losartan group and the spironolactone group, the combination group was low, the control group was (405.00-102.74) ml, and the losartan group (686.2 7 (263.41) ml, the spironolactone group (711.54-302.87) ml, the combination group (603.85-233.15) ml, the difference had statistical significance (P = 0.012), and the difference between the four groups of other time points There was no significant difference (P0.05).4. There was no significant difference in the amount of ultrafiltration (P0.05). No statistics Conclusion:1. With the prolongation of the dialysis time, the residual renal function and the urine volume of the patients with maintenance peritoneal dialysis are presented. Gradually decreasing, the rate of peritoneal solute transport is increasing gradually.2. Losartan of the angiotensin receptor antagonist can delay the abdomen. 3. Aldosterone receptor antagonist spironolactone can delay the residual renal function. 4. Short-term combination of angiotensin receptor antagonists and aldosterone receptor antagonists for peritoneal dialysis
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5
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