小剂量瑞舒伐他汀联合血脂康对肾动脉粥样硬化性高血压的疗效及安全性分析

发布时间：2018-05-29 01:55

本文选题：肾动脉狭窄 + 动脉粥样硬化　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:本研究主要应用小剂量瑞舒伐他汀联合中药血脂康治疗肾动脉粥样硬化性高血压,进而评价其疗效及安全性。方法:2015.6-2016.6期间入选吉林大学第二医院住院高血压患者90例(肾动脉无狭窄组15例+肾动脉狭窄组75例),其中肾动脉狭窄经肾动脉彩超及肾动脉CTA诊断,在治疗过程中肾动脉狭窄患者中有3名患者中途退出(1名在治疗过程中出现单侧肾动脉完全闭塞,余2名行肾动脉PCI治疗)。将余72例肾动脉狭窄患者根据给予不同的治疗方案分为对照组N组(仅给予降压药物n=18)、西药治疗组A组(降压药物+瑞舒伐他汀10mg n=18)、中药治疗组B组(降压药物+血脂康1200mg n=18)、小剂量中西药联合治疗组C组(降压药物+瑞舒伐他汀5mg+血脂康1200mg n=18)。评价如下内容:1)探讨肾动脉粥样硬化性高血压的发病机制,为临床降脂药物应用于此类高血压的治疗提供理论依据。2)测定血脂及动脉粥样硬化炎症因子(同型半胱氨酸(Hcy)、髓过氧化物酶(MPO)、内皮素-1(ET-1)一氧化氮(NO)及肾素)水平,观察其与肾动脉狭窄程度是否存在相关性。3)N、A、B、C四组患者治疗1个月、6个月及12个月后,观察其血脂、收缩压(SBP)、舒张压(DBP)、肾功能(Cr、GFR)、转氨酶(AST、ALT)及肌酸激酶(CK)水平的变化;12个月时复查MPO、Hcy、NO、ET-1情况,并通过肾动脉彩超或肾动脉CTA评价肾动脉狭窄程度的改善情况。4)评价各治疗方案的安全性,为肾动脉粥样硬化性高血压患者提供最佳的治疗方案。结果：1)高血压伴肾动脉狭窄组中对照组(N组)、西药治疗组(A组)、中药治疗组(B组)、小剂量中西药联合治疗组(C组)四组年龄、性别、体重、BMI、吸烟史、糖尿病、脑卒中、冠心病病史以及服用血管紧张素转换酶抑制剂(ACEI)与钙离子拮抗剂(CCB)降压药物人数比例无统计学差异(P0.05),而肾动脉狭窄各组高血压患者的吸烟人数、合并糖尿病、脑卒中及冠心病比例明显高于肾动脉无狭窄组,且差异具有统计学意(P0.05);2)高血压伴肾动脉狭窄组SBP明显高于肾动脉无狭窄组(P0.05),但两组DBP差距较小,差异无明显统计学意义(P0.05);3)高血压伴肾动脉狭窄组(N、A、B、C四组)SBP及DBP情况治疗1年后均较治疗前明显降低,差异具有统计学意义(P0.05)。在治疗6个月及12个月时给予降脂治疗的A、B、C三组较N组SBP降低更为明显,具有统计学意义(P0.01);经治疗6个月时A、B、C三组较N组DBP明显降低,具有统计学意义(P0.01);12个月时A、C两组DBP降低较N、B两组更为明显,具有统计学意义(P0.01);而A组与C组、N组与B组之间DBP降低无统计学意义(P0.05);4)高血压伴肾动脉狭窄组72例患者治疗前TC、LDL-C水平高于肾动脉无狭窄组(P0.05);在治疗12个月时A、B、C三组TC、TG、LDL-C水平明显低于治疗前,HDL-C水平高于治疗前,比较具有统计学意义(P0.05)。治疗6个月及12个月时A、C两组TC减低幅度明显优于B组,比较具有统计学意义(P0.05);治疗12个月时A、C两组TG减低幅度明显优于B组,比较具有统计学意义(P0.05);治疗6个月及12个月时C组LDL-C减低幅度优于A、B两组,比较具有统计学意义(P0.05);而给予降脂治疗的三组HDL-C治疗前后差异无统计学意义(P0.05);5)高血压伴肾动脉狭窄组(N、A、B、C四组)治疗1年后肾动脉收缩期最大血流速度(PSV)水平明显低于治疗前(P0.05)。A、B、C三组较N组降低更为明显(P0.05)。且A、C两组改善情况优于B组(P0.05);A、C两组间无明显差异(P0.05)。6)72例高血压伴肾动脉狭窄患者中有28例经肾动脉CTA确诊,根据肾动脉管腔狭窄程度其分为轻度(50%)、中度(50%-75%)和重度(76-99%)。经治疗1年后A、B、C三组中,重度狭窄人数无明显变化,而中度狭窄人数较之前有所减低(P0.05),且A组略优于B、C组,但差异无统计学意义(P0.05)。7)高血压伴肾动脉狭窄组72例患者中NO、ET-1、MPO、肾素以及Hcy水平明显高于肾动脉无狭窄组(P0.05),经治疗1年后给予降脂治疗的A、B、C三组NO、ET-1、MPO及Hcy水平水平较前明显减低(P0.05),除MPO指标外,余指标C组均较A、B两组降低幅度明显(P0.05)。A、C两组MPO值较B组降低明显(P0.05);8)高血压伴肾动脉狭窄组72例患者治疗前MPO水平与LDL-C水平呈正相关(R=0.290,P=0.014)。该72例患者治疗前PSV水平与SBP和DBP水平呈正相关(R=0.873,P0.01);9)高血压伴肾动脉狭窄组(N、A、B、C四组)治疗前GFR中度降低(30~60ml/min)人数所占比例差异无统计学意义(P0.05);经治疗1年后A、B、C三组GFR中度人数所占比例低于治疗前(P0.05);而A、C两组较B组比例更低(P0.05);A、C两组间无明显差异(P0.05)。10)高血压伴肾动脉狭窄组(N、A、B、C四组)各组治疗前后ALT、AST及水平无明显差异(P0.05)。11)72例高血压伴肾动脉狭窄组(N、A、B、C四组)各组治疗前后虽CK水平变化具有统计学意义(P0.05)。但与治疗前相比各组CK值未见明显升高,且无患者出现肌痛现象。12)在给予降脂药物三组(A、B、C三组)中仅3例患者出现一过性胃肠道反应。结论:1)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、肾素、髓过氧化物酶(MPO)、同型半胱氨酸(Hcy)、一氧化氮(NO)以及内皮素-1(ET-1)共同参与肾动脉粥样硬化性高血压的形成;2)、肾动脉粥样硬化患者肾动脉狭窄程度与收缩压(SBP)和舒张压(DBP)水平呈正相关;3)、在给予降脂、抗炎、抗氧化应激治疗后,肾动脉粥样硬化患者的血压、TC、LDL-C、MPO、Hcy、NO、ET-1水平较治疗前明显减低,以小剂量瑞舒伐他汀联合血脂康效果最为显著;4)、小剂量瑞舒伐他汀联合血脂康在治疗肾动脉粥样硬化性高血压具有较好的安全性。
[Abstract]:Objective: This study mainly used small dose rosuvastatin and xuexuekang in the treatment of renal atherosclerotic hypertension, and then evaluated its efficacy and safety. Methods: during the period of 2015.6-2016.6, 90 cases of hypertensive patients were admitted to second hospitals of Jilin University (15 cases of renal artery stenosis group + renal artery stenosis group 75 cases), including renal artery. By renal artery color Doppler ultrasound and renal artery CTA diagnosis, 3 patients were withdrawn from the renal artery stenosis during the treatment process (1 in the treatment process, the unilateral renal artery was completely obliterate, and the remaining 2 were treated with renal artery PCI). The remaining 72 patients with renal artery stenosis were divided into the control group N group according to the different treatment schemes. Pressure drug n=18), western medicine treatment group A group (antihypertensive drugs + rosuvastatin 10mg n=18), Chinese medicine treatment group B group (antihypertensive drugs + Xuezhikang 1200mg n=18), small dose of Chinese and Western medicine group C group (antihypertensive drugs + rosuvastatin 5mg+ Xuekang 1200mg n=18). Evaluation of the following contents: 1) to explore the pathogenesis of renal atherosclerotic hypertension. To provide a theoretical basis for the use of clinical lipid lowering drugs in the treatment of such hypertension (.2) to determine the levels of blood lipids and atherosclerotic inflammatory factors (homocysteine (Hcy), myeloperoxidase (MPO), endothelin -1 (ET-1) nitric oxide (NO) and renin), and whether there is a correlation with the degree of renal artery stenosis in.3) N, A, B, C four. After 1 months, 6 months and 12 months, the changes of blood lipid, systolic pressure (SBP), diastolic pressure (DBP), renal function (Cr, GFR), transaminase (AST, ALT) and creatine kinase (CK) were observed, and MPO, Hcy, NO, and ET-1 were reviewed at 12 months, and the treatment regimens were evaluated by renal artery color Doppler ultrasound or renal artery CTA evaluation of renal artery stenosis. Safety, to provide the best treatment for patients with renal atherosclerotic hypertension. Results: 1) hypertension with renal artery stenosis group (group N), western medicine treatment group (group A), Chinese medicine treatment group (group B), small dose of Chinese and Western medicine group (group C) group (group C) of age, sex, weight, BMI, smoking history, diabetes, stroke, coronary heart disease history There was no significant difference in the proportion of antihypertensive drugs with angiotensin converting enzyme inhibitor (ACEI) and calcium ion antagonist (CCB), while the number of smokers in hypertensive patients with renal artery stenosis, diabetes, cerebral apoplexy and coronary heart disease were significantly higher than those in the renal artery without stenosis, and the difference was statistically significant (P0.05); 2) The SBP in the blood pressure and renal artery stenosis group was significantly higher than that of the renal artery stenosis group (P0.05), but the difference between the two groups was smaller and the difference was not significant (P0.05); 3) the cases of hypertension and renal artery stenosis group (N, A, B, C four) were significantly lower than before the treatment (P0.05) after 1 years, and the difference was statistically significant (P0.05). In the treatment of 6 months and 12 months. A, B, C three in the three groups were significantly lower than those in the N group, with statistical significance (P0.01), while the A, B, C three groups were significantly lower than those in the N group after 6 months of treatment, with statistical significance (P0.01); 12 months, two groups were lower than those in the two groups. There was no statistical significance (P0.05); 4) in 72 patients with hypertension and renal artery stenosis, the level of LDL-C was higher than that of the renal artery without stenosis group (P0.05), and the level of TC, TG, LDL-C in group A, B, C three was significantly lower than that before treatment for 12 months, and the HDL-C level was higher than that before the treatment, which was significantly higher than that before the treatment (P0.05). Two groups were treated for 6 months and 12 months. The reduction was significantly better than that in the B group (P0.05). The TG reduction amplitude in A and C two groups was significantly better than that in group B (P0.05) at 12 months of treatment, and the decreasing amplitude of LDL-C in group C was superior to A and B two at 6 months and 12 months, and the three groups were given lipid lowering treatment before treatment. There was no statistical significance (P0.05); 5) the maximum blood flow velocity (PSV) of renal artery systolic blood flow rate (PSV) was significantly lower than that before treatment (P0.05).A, B and C three were significantly lower than that of N group (P0.05) in the group of hypertension and renal artery stenosis group (group N, A, B, C four) after 1 years of treatment (P0.05). Moreover, the two groups were better than those in the group of 72. 72 cases had no significant difference between the two groups. 28 cases of hypertensive patients with renal artery stenosis were diagnosed by renal artery CTA. According to the degree of renal artery stenosis, they were divided into mild (50%), moderate (50%-75%) and severe (76-99%). After 1 years of treatment, there was no significant change in the number of severe stenosis in group A, B and C, but the number of moderate narrow narrowing was lower than before (P0.05), and A group was slightly better than B, C group, but poor but poor. No statistical significance (P0.05).7) the levels of NO, ET-1, MPO, renin and Hcy in 72 patients with hypertension and renal artery stenosis were significantly higher than those in the renal artery without stenosis group (P0.05). After 1 years of treatment, the levels of A, B, C three were significantly lower than those in the previous group. Except for the index, the remaining indexes were all lower than those in the two groups. The low amplitude (P0.05).A, C two group MPO values were lower than those in the B group (P0.05); 8) there was a positive correlation between MPO level and LDL-C level in 72 patients with renal artery stenosis before treatment (R=0.290, P=0.014). The PSV level in the 72 patients before treatment was positively correlated with the level of SBP, 9) treatment of renal artery stenosis group (four groups). There was no significant difference in the proportion of GFR moderate decrease (30~60ml/min) before treatment (P0.05). After 1 years of treatment, the proportion of moderate number of GFR in group A, B, C three was lower than that before treatment (P0.05); and A, C two was lower than B group (P0.05). There was no significant difference in post ALT, AST and level (P0.05).11) 72 cases of hypertension with renal artery stenosis group (N, A, B, C four), the changes of CK levels were statistically significant before and after treatment (P0.05). But there was no significant increase in CK values compared with those before treatment, and no patients appeared muscle pain.12) in the three groups (three groups). Conclusion: 1) total cholesterol (TC), low density lipoprotein (LDL-C), renin, myeloperoxidase (MPO), homocysteine (Hcy), nitric oxide (NO) and endothelin -1 (ET-1) are involved in the formation of renal atherosclerotic hypertension; 2) the degree of renal artery stenosis and systolic blood pressure in patients with renal atherosclerosis. (SBP) and diastolic pressure (DBP) level positive correlation; 3) after the treatment of lipid lowering, anti-inflammatory, and antioxidant stress, the blood pressure, TC, LDL-C, MPO, Hcy, NO, ET-1 in patients with renal atherosclerosis were significantly lower than before the treatment, and the effect of small dose of rosuvastatin combined with Xuezhikang was the most significant; 4) small dose of rosuvastatin combined with Xuezhikang in the treatment of kidney Atherosclerotic hypertension has better safety.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R692

【相似文献】