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目的观察苯磺酸左旋氨氯地平与坎地沙坦酯对原发性高血压伴蛋白尿患者的肾保护作用。方法根据24 h尿蛋白总量(Pro)和使用药物的不同,将208例原发性高血压伴蛋白尿患者分为4组:A组(1 g/24 h≤Pro<3.5 g/24 h)服用苯磺酸左旋氨氯地平2.5 mg·d~(-1),B组(1 g/24 h≤Pro<3.5 g/24 h)服用坎地沙坦酯4 mg·d~(-1),C组(Pro<1 g/24 h)服用苯磺酸左旋氨氯地平2.5mg·d~(-1),D组(Pro<1 g/24 h)服用坎地沙坦酯4 mg·d~(-1)。各组均观察48周,比较治疗后肾小球滤过率(GFR)、尿蛋白及血压的情况。结果治疗28周后,A组的肾小球滤过率为(59.42±38.11)m L/1.73 m2·min,B组为(60.13±9.72)m L/1.73 m2·min,C组为(58.32±10.21)m L/1.73 m2·min,D组为(58.73±9.41)m L/1.73 m2·min,治疗48周后,A组肾小球滤过率为(66.30±81.92)m L/1.73 m2·min,B组肾小球滤过率为(67.36±11.74)m L/1.73 m2·min,C组肾小球滤过率为(66.13±9.11)m L/1.73 m2·min,D组肾小球滤过率为(68.26±10.52)m L/1.73 m2·min,与治疗前比较,差异均有统计学意义(均P<0.01),但是各组间肾小球滤过率差异无统计学意义(P>0.05)。C组治疗28周的Pro为(0.38±0.05)g/24 h,治疗48周的Pro为(0.35±0.04)g/24 h,与D组的(0.20±0.06)g/24 h,(0.18±0.03)g/24 h比较,差异有统计学意义(P<0.01)。治疗15,28和48周后,A组与B组、C组与D组间血压差异均无统计学意义(P>0.05)。4组治疗期间均未发生药物过敏和肝肾功能损伤等药物不良反应。结论苯磺酸左旋氨氯地平和坎地沙坦酯在保护原发性高血压伴蛋白尿患者肾功能方面作用相似,但坎地沙坦酯在减少蛋白尿方面更有优势。
Objective To observe the renal protective effect of levamlodipine besylate and candesartan cilexetil on patients with essential hypertension complicated with proteinuria. Methods 208 patients with essential hypertension with proteinuria were divided into 4 groups according to the total amount of 24 h urine protein (Pro) and the drugs used: group A (1 g / 24 h≤Pro <3.5 g / 24 h ) Were treated with candesartan cilexetil 4 mg · d ~ (-1) and levamlodipine besylate 2.5 mg · d ~ (-1) in group B (1 g / 24 h≤Pro <3.5 g / 24 h) ) In group C (Pro <1 g / 24 h) were treated with levamlodipine besylate 2.5 mg · d -1, group D (Pro <1 g / 24 h) · D ~ (-1). All groups were observed for 48 weeks, compared with the treatment of glomerular filtration rate (GFR), urinary protein and blood pressure. Results After 28 weeks of treatment, the glomerular filtration rate in group A was (59.42 ± 38.11) m L / 1.73 m 2 · min, in group B was 60.13 ± 9.72 m L / 1.73 m 2 · min, in group C was 58.32 ± 10.21) m L / 1.73 m 2 · min in group D and (58.73 ± 9.41) m L / 1.73 m 2 · min in group D, and the GFR of group A was (66.30 ± 81.92) m L / 1.73 m2 · min. The glomerular filtration rate in group B was (67.36 ± 11.74) m L / 1.73 m 2 · min. The glomerular filtration rate in group C was (66.13 ± 9.11) m L / 1.73 m 2 · min. The glomerular filtration rate was (68.26 ± 10.52) m L / 1.73 m 2 · min, which was significantly different from that before treatment (all P <0.01), but there was no difference in glomerular filtration rate Statistical significance (P> 0.05). Pro in group C was (0.38 ± 0.05) g / 24 h after 28 weeks of treatment and (0.35 ± 0.04) g / 24 h in 48 weeks and (0.20 ± 0.06) g / 24 h and ± 0.03) g / 24 h, the difference was statistically significant (P <0.01). After 15, 28 and 48 weeks of treatment, there was no significant difference in blood pressure between group A and group B, group C and group D (P> 0.05). No adverse reactions such as drug allergy and liver and kidney dysfunction occurred during the 4 groups. Conclusions Levamlodipine besilate and candesartan cilexetil have similar effects in protecting renal function in patients with essential hypertension and proteinuria, but candesartan cilexetil has more advantages in reducing proteinuria.