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目的比较常规剂量与高剂量缬沙坦对慢性肾小球肾炎合并高血压的肾脏保护作用。方法选取2015年6月-2016年6月医院收治的慢性肾小球肾炎合并高血压患者84例,按数字奇偶法分为2组,每组42例。常规剂量组给予缬沙坦80 mg/d口服,高剂量组给予缬沙坦160 mg/d口服。2组均治疗6个月,测定2组治疗前后血压、血钾、24 h尿蛋白、血清肌酐、肾小球滤过率水平,比较2组治疗效果及用药安全性。结果 2组治疗前血压、血钾、24 h尿蛋白、血清肌酐及肾小球滤过率比较差异均无统计学意义(P>0.05)。2组治疗后收缩压(SBP)、舒张压(DBP)水平较治疗前均有所下降(P<0.05),但2组治疗后SBP、DBP水平比较差异无统计学意义(P>0.05);2组治疗前后血钾水平比较差异均无统计学意义(P>0.05);2组治疗后24 h尿蛋白水平较治疗前均有所下降(P<0.05),且高剂量组低于对照组(P<0.05);常规剂量组治疗后血清肌酐水平较治疗前上升(P<0.05),肾小球滤过率下降(P<0.05);高剂量组治疗后血清肌酐、肾小球滤过率无明显变化(P>0.05);治疗后2组血清肌酐、肾小球虑过率比较差异有统计学意义(P<0.05)。高剂量组治疗总有效率为92.86%高于常规剂量的76.19%,差异有统计学意义(P<0.05)。2组治疗期间均进行血常规、血糖、血脂、肝功能检查,未见明显不良反应发生。结论缬沙坦在慢性肾小球肾炎合并高血压治疗中有良好的降压效果,但高剂量缬沙坦在保护肾脏作用方面有更好疗效,且用药安全。
Objective To compare the renal protective effects of conventional and high dose valsartan on chronic glomerulonephritis with hypertension. Methods Eighty-four patients with chronic glomerulonephritis and hypertension were selected from June 2015 to June 2016 in our hospital. They were divided into two groups according to the number parity method, 42 in each group. Routine doses of valsartan 80 mg / d orally, high-dose group were given valsartan 160 mg / d orally. The two groups were treated for 6 months. Blood pressure, serum potassium, 24h urinary protein, serum creatinine and glomerular filtration rate were measured before and after treatment in two groups. The therapeutic effect and medication safety were compared between the two groups. Results There was no significant difference in blood pressure, serum potassium, 24h urinary protein, serum creatinine and glomerular filtration rate before treatment in both groups (P> 0.05). SBP and DBP decreased in both groups after treatment (P <0.05), but there was no significant difference in SBP and DBP between the two groups after treatment (P> 0.05). There was no significant difference in serum potassium levels between the two groups before and after treatment (P> 0.05). Urinary protein levels in 24 hours after treatment in both groups decreased (P <0.05), and were lower in the high-dose group than those in the control group (P <0.05). The serum creatinine level in the conventional treatment group was significantly higher than that before treatment (P <0.05), and glomerular filtration rate was decreased (P <0.05). Serum creatinine, glomerular filtration rate There was no significant difference in the rate of serum creatinine and glomerular filtration (P> 0.05) between the two groups after treatment (P <0.05). The total effective rate of high-dose group was 92.86% higher than 76.19% of the conventional dose, the difference was statistically significant (P <0.05). During the treatment, blood routine, blood glucose, blood lipid and liver function were examined in both groups, and no obvious adverse reactions occurred. Conclusion Valsartan has a good antihypertensive effect in the treatment of chronic glomerulonephritis with hypertension, but the high-dose valsartan has a better curative effect in protecting the kidneys and the medication is safe.