厄贝沙坦治疗原发性高血压肾损害早期的疗效分析

发布时间：2018-06-18 03:33

本文选题：厄贝沙坦 + 硝苯地平缓释片　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:原发性高血压是常见的心血管疾病,也是导致人类死亡的常见疾病之一,如脑卒中、冠心病、肾功能衰竭、心力衰竭等。肾脏是调节血压的重要器官,且常是高血压受累的主要器官之一[1]。其发生机制目前尚不完全清楚,可能与肾血液动力学改变及血管内皮损害有关[2 3]。厄贝沙坦为新型血管紧张素Ⅱ受体拮抗剂(Angiotensin receptor blocker,ARB),具有降低尿蛋白及改善血管内皮功能的作用[4]。临床中对原发性高血压合并早期肾损害的患者,降压药物的选择并无统一标准。本实验通过观察应用厄贝沙坦、硝苯地平缓释片治疗原发性高血压疗效,监测肾早期损害指标:血清胱抑素C(Cystatin,Cys-C)、尿转铁蛋白(Urinary transferin,U-TRF),尿微量白蛋白(Urine microalbumin,Um Alb),α1微球蛋白(Alpha1 microglobulin,α1-mG),N乙酰β-氨基葡萄糖苷酶(Urineβ-N-Acetyl glucosaminidase,NAG)水平,随后进行综合分析,证实厄贝沙坦、硝苯地平缓释片治疗原发性高血压有效,而厄贝沙坦对早期肾损害有保护作用,能延缓慢性肾脏病的进展,提高患者生活质量,为临床治疗提供参考依据。方法:1研究对象:选取2011年9月-2013年9月于衡水市哈励逊国际和平医院门诊就诊的初次就诊未服降压药物的患者,入组前均符合我国高血压防治指南修订委员会制定的《中国高血压防治指南》(2010年修订版第三版),均为2级高血压,临床无症状,尿微量白蛋白/肌酐比值介于30-300mg/g,血胱抑素(Cys-c)升高,二者并存或其中一项大于正常值。肾功能、血肌酐正常,同时需排除继发性高血压、原发性肾脏疾病、痛风、心脏瓣膜病、心肌病、糖尿病、感染、血液病、肝功能异常和自身免疫性疾病等。本课题共收集56例患者,随机对照分为厄贝沙坦组、硝苯地平缓释片组,厄贝沙坦组男15例,女14例,平均年龄(58±10.4)岁;硝苯地平缓释片组男13例,女14例,平均年龄(59±9.2)岁。两组在性别、年龄、体重方面差异无显著性(P0.05),具有可比性。2方法:厄贝沙坦组起始口服量为150mg/d,硝苯地平缓释片组起始口服量为10mg/d,若1周后血压≥140/90mm Hg,逐渐增加药物剂量,厄贝沙坦组最大剂量300mg/d;硝苯地平缓释片组最大剂量40mg/d。连续口服10周,目标血压定为安静坐位血压140/90mm Hg,每周测量血压至少4次。2周后血压不能控制至目标水平者加用美托洛尔25-50mg/d,若血压仍不能控制退出本实验,厄贝沙坦组退出2例,硝苯地平缓释片组退出1例。厄贝沙坦组失访1例,硝苯地平缓释片组失访1例。血压控制在140/90mm Hg以后维持当前剂量,并观察药物不良反应。3观察指标:所选对象采用每周测量血压至少4次,并分别在治疗前及治疗后第2、4、8、10周清晨空腹(禁食8-12小时)抽取静脉血3ml在Cobas 8000上检测Cys-c;同时段收集新鲜中段晨尿在SIEMENS BNⅡ上检测U-TRF、Um Alb、U-α1-mG、NAG的水平。根据化验结果比较厄贝沙坦组及硝苯地平缓释片组治疗效果的差异。4统计学方法:采用SPSS 19.0统计软件对所得数据进行分析,计量资料用均数±标准差((?)±s)表示,行配对t检验,计数资料以率表示,采用x2检验,以P0.05为差异无统计学意义,P0.05为差异具有统计学意义。结果:1两组患者在年龄、性别、体重、用药前Cys-c、U-TRF、Um Alb、U-α1-mG、NAG水平上均无明显差异(P0.05)。2厄贝沙坦组降低2级原发性高血压患者收缩压及舒张压有统计学差异(P0.05)。3硝苯地平缓释片组降低2级原发性高血压患者收缩压及舒张压有统计学差异(P0.05)。4治疗前厄贝沙坦组、硝苯地平缓释片组收缩压、舒张压数值比较无统计学意义(P0.05);治疗后两组收缩压、舒张压数值比较无统计学意义(P0.05)。5硝苯地平缓释片组治疗后Cys-c、U-TRF、Um Alb、U-α1-mG、NAG降低,较治疗前有统计学差异(P0.05)。6厄贝沙坦组治疗后Cys-c、U-TRF、Um Alb、U-α1-mG、NAG降低,较治疗前有统计学差异(P0.05)。7厄贝沙坦组较硝苯地平缓释片组治疗后降Cys-c、U-TRF、Um Alb、U-α1-mG、NAG有统计学差异(P0.05)。结论:本研究数据显示:厄贝沙坦组、硝苯地平缓释片组治疗2级原发性高血压均有效;厄贝沙坦组、硝苯地平缓释片组治疗后Cys-c、U-TRF、Um Alb、U-α1-mG、NAG水平降低。两组比较厄贝沙坦能更有效地降低肾早期损伤指标。
[Abstract]:Objective: essential hypertension is a common cardiovascular disease, which is one of the common diseases that cause human death, such as stroke, coronary heart disease, renal failure and heart failure. The kidney is an important organ for regulating blood pressure and is often one of the main organs involved in hypertension, [1]. is not completely clear and may be associated with renal blood. Dynamic changes and vascular endothelial damage related to [2 3]. erbesartan is a new angiotensin II receptor antagonist (Angiotensin receptor blocker, ARB), which has the effect of reducing urine protein and improving vascular endothelial function in [4]. clinical patients with primary hypertension and early renal damage, the selection of antihypertensive drugs has no unified standard. The effect of irbesartan and Extended Release Nifedipine Tablets in the treatment of primary hypertension was observed in this experiment. The indexes of early renal damage were monitored: serum cystatin C (Cystatin, Cys-C), urinary transferrin (Urinary transferin, U-TRF), urinary microalbumin (Urine microalbumin, Um Alb), alpha 1 microglobulin (Alpha1 microglobulin, alpha), acetacetyl beta ammonia The level of Urine beta -N-Acetyl Glucosaminidase (NAG) and subsequent comprehensive analysis confirmed that erbesartan is effective in the treatment of essential hypertension, while irbesartan has protective effects on early renal damage. It can delay the progression of chronic kidney disease, improve the quality of life, and provide reference for clinical treatment. Methods: 1 research subjects: selected patients who did not take antihypertensive drugs in the outpatient department of Hengshui Halison International Peace Hospital in September 2011 -2013, were all in line with the China guidelines for hypertension prevention and control (third edition of 2010 Revision), which were all in grade 2 hypertension. The bed was asymptomatic, the ratio of urine microalbuminuria / creatinine was between 30-300mg/g and serum cystatin (Cys-c). The coexistence of two or one of them was greater than normal. Renal function, blood creatinine was normal, and secondary hypertension, primary kidney disease, gout, heart valvular disease, cardiomyopathy, diabetes, infection, blood disease, liver dysfunction, and self immunity 56 patients were randomly divided into erbesartan group, Extended Release Nifedipine Tablets group, erbesartan Group 15, female 14, average age (58 + 10.4) years, 13 men in Extended Release Nifedipine Tablets group and 14 female, average age (59 + 9.2) years. There was no significant difference in sex, age and weight (P0.05) in the two group (two group). Comparable.2 method: the initial oral dose of erbesartan group was 150mg/d and the initial oral dose of Extended Release Nifedipine Tablets group was 10mg/d. If the blood pressure was more than 140/90mm Hg 1 weeks later, the drug dosage was gradually increased, the maximum dose of irbesartan group was 300mg/d, the maximum dose of 40mg/d. in Extended Release Nifedipine Tablets group was 10 weeks, and the target blood pressure was set as the quiet sitting position of the blood pressure 140. /90mm Hg, when the blood pressure was measured at least 4 times a week for at least 4 weeks, the blood pressure was not controlled at the target level plus metoprolol 25-50mg/d. If the blood pressure was still not controlled to exit the experiment, the erbesartan group withdrew from 2 cases, the Extended Release Nifedipine Tablets group withdrew from 1 cases, the Irbesartan group lost 1 cases, and the Extended Release Nifedipine Tablets group lost 1 cases. The blood pressure control was in 140/90mm Hg. To maintain the current dose, and to observe the.3 observation index of adverse drug reactions: the selected subjects were measured at least 4 times a week, and the venous blood 3ml was detected on Cobas 8000 before and after 2,4,8,10 week (fasting) in the morning before and after the treatment (8-12 hours), and at the same time, the fresh middle morning urine was collected to detect U-TR on SIEMENS BN II. F, Um Alb, U- alpha 1-mG, NAG level. According to the test results, compare the difference between the ebesartan group and the Extended Release Nifedipine Tablets group,.4 statistics method: the data were analyzed by the SPSS 19 statistical software, the measurement data were shown with the mean + standard deviation ((?) + s), the paired t test, the count data were expressed, the x2 test was adopted, and P was used for P. 0.05 the difference was not statistically significant, P0.05 was statistically significant. Results: 1 two groups of patients in age, sex, weight, before Cys-c, U-TRF, Um Alb, U- alpha 1-mG, NAG level were not significantly different (P0.05).2 in the erbesartan group decreased the systolic pressure and diastolic pressure of grade 2 primary hypertension (P0.05).3 nifedipine There was significant difference in systolic pressure and diastolic pressure in patients with 2 grade primary hypertension (P0.05). There was no significant difference in systolic pressure and diastolic pressure in Extended Release Nifedipine Tablets group before.4 treatment (P0.05). There was no significant difference in systolic pressure and diastolic pressure in the two groups after treatment (P0.05).5 Extended Release Nifedipine Tablets group After treatment, Cys-c, U-TRF, Um Alb, U- alpha 1-mG, NAG decreased, and there were statistical differences compared with those before treatment (P0.05). Conclusion: the data of this study showed that the erbesartan group and Extended Release Nifedipine Tablets group were effective in the treatment of grade 2 primary hypertension; the erbesartan group and the Extended Release Nifedipine Tablets group were treated with Cys-c, U-TRF, Um Alb, U- alpha 1-mG, and NAG level decreased. The two groups were more effective in reducing the index of early renal injury.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R692

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