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目的:探讨血管紧张素Ⅱ受体阻滞剂(ARB)剂量对高龄高血压合并慢性肾脏病(CKD)3期患者疗效及安全性的影响。方法:研究对象选取2011年7月-2015年7月高龄高血压合并CKD3期患者共208例,采用随机数字表法分为对照组(104例)和观察组(104例),在苯磺酸氨氯地平基础上分别加用坎地沙坦常规剂量和加倍剂量辅助治疗;比较2组患者治疗前后血压水平、肾脏功能指标、胱抑素C(Cys-C)、超敏C反应蛋白(hs-CRP)及内皮素1(ET-1)、电解质离子及谷氨酸-丙酮酸转氨酶(ALT)水平等。结果:2组患者治疗后SBP、DBP、Scr、BUN、mAlb、β2-MG、Cys-C、hs-CRP及ET-1水平均显著低于治疗前,差异具有显著性(P<0.05);观察组患者治疗后以上各项指标水平均显著低于对照组,差异具有显著性(P<0.05);同时2组患者治疗前后电解质离子和ALT水平比较差异无显著性(P>0.05)。结论:相较于常规剂量,ARB加倍剂量应用于高龄高血压合并CKD3期患者治疗可有效降低血压水平,促进受损肾脏功能恢复,改善实验室相关指标水平,且未对机体电解质平衡紊乱和肝脏功能产生不利影响。
Objective: To investigate the effect of angiotensin Ⅱ receptor blocker (ARB) on the efficacy and safety of elderly patients with hypertension and chronic kidney disease (CKD) stage Ⅲ. Methods: A total of 208 elderly patients with hypertension and CKD3 from July 2011 to July 2015 were selected and divided into control group (104 cases) and observation group (104 cases) by random number table. Amlodipine were added on the basis of candesartan conventional dose and double dose adjuvant therapy; two groups of patients before and after treatment, blood pressure levels, renal function, Cystatin C (Cys-C), high-sensitivity C reactive protein -CRP) and endothelin-1 (ET-1), electrolyte ions and glutamate-pyruvate aminotransferase (ALT) levels. Results: The levels of SBP, DBP, Scr, BUN, mAb, β2-MG, Cys-C, hs-CRP and ET-1 in the two groups were significantly lower than those before treatment (P <0.05) The levels of the above indexes in the observation group were significantly lower than those in the control group (P <0.05). There was no significant difference in electrolyte ion and ALT between the two groups before and after treatment (P> 0.05). Conclusion: Compared with the conventional dose, doubled dose of ARB in elderly patients with hypertension and CKD3 treatment can effectively reduce blood pressure levels, promote the recovery of impaired renal function, improve the level of laboratory related indicators, and not on the electrolyte imbalance and liver Function has a negative impact.