氯沙坦治疗狼疮肾炎合并高血压疗效比较

Effect of losartan on patients with lupus nephritis and hypertension

目的比较血管紧张素Ⅱ受体拮抗剂（ARB）氯沙坦（科素亚）与钙离子拮抗剂治疗狼疮肾炎合并高血压患者血压、肾功能和尿蛋白的改变。方法狼疮肾炎合并高血压患者36例,给予强的松标准方案与环磷酰胺1克/月。其中18例给予氯沙坦50-100mg/d,18例硝苯地平缓释片20-30mg/d,口服,血压控制在140/90mmHg以下,2周未达标患者可增加联合用药。治疗前后测血压并观察Scr、BUN、URIC、ALB、血K＋、24小时尿蛋白定量,连续3月。结果氯沙坦组血压由（165.4±23.2）/（103.2±16.4）mmHg降至（134.3±19.3）/（81.2±17.7）mmHg,硝苯地平缓释片组血压由（166.4±22.4）/（104.3±18.2）mmHg降至（133.2±21.4）/（79.8±18.3）mmHg,两比较差异无显著性意义（P〉0.05）;治疗前后蛋白尿变化,氯沙坦组[（3.7±0.7）vs（1.2±0.5）g/d,P〈0.05],硝苯地平缓释片组[（3.9±0.9）vs（1.8±0.6）g/d,P〈0.05];氯沙坦组尿蛋白降低较硝苯地平缓释片组更明显（P〈0.05）。结论氯沙坦可有效降低血压、更好地降低尿蛋白,是狼疮肾炎综合治疗措施的较好选择。

Objective To compare the effects of losartan and extended released nifedipine （ERN） on blood pressure, proteinuria and renal function in patients with lupus nephritis and hypertension. Methods Thirty-six patients with lupus nephritis and hypertension were enrolled in this study. All of the patients received standard prednisone and cyclophosphamide （ 1 g/M ） protocol. Patients were divided into two groups and each one had 18 patients. One group was treated with losartan （ 50 - 100 mg/ d） , another was treated with ERN（20 -30 mg/d）. The target blood pressure was less than 140/90 mmHg. If the blood pressure failed to reach the target blood pressure, the combination medications would be added. The blood pressure, Scr, BUN, URIC, ALB, K ± , and proteinuria were monitored once a month for three times. Results The systolic blood pressure decreased from （ 165.4 ± 23.2 ） mmHg to （ 134. 3 ± 19.3 ） mmHg in losartan group, and from （ 166.4 ± 22.4 ） mmHg to （ 133.2 ± 21.4 ） mmHg in ERN group. The diastolic blood pressure decreased from （ 103.2 ± 16. 4） mmHg to （ 81.2 ±17.7 ） mmHg in losartan group, and from （ 104. 3 ± 18.2 ） mmHg to （ 79.8 ± 18.3 ） mmHg in ERN group. There was no significant difference between the two groups （ P 〉 0.05 ）. The proteinuria decreased significantly in the losartan group [ （ 3.7 ± 0.7 ） vs （ 1.2 ± 0.5 ） g/d, P 〈 0. 05] ,and the ERN group[ （3.9 ±0. 9） vs （ 1.8 ±0. 6） g/d, P 〈 0. 05]. Losartan alleviated the proteinuria more effectively than ERN. There was no significant difference in BUN, Scr and ALB between the two groups. Conclusion Losartan can efficiently decrease blood pressure and alleviate proteinuria. It is an alternative of treatment for patients with lupus nephritis.