伊贝沙坦与依那普利联用改善高血压病早期肾损害的观察

Combination of irbesartan and enalapril in improving early renal damage in hypertensive patients

目的： 评价伊贝沙坦合用依那普利对原发性高血压患者早期肾功能损害的有效性和安全性。方法： 将110例经血、尿中β2微球蛋白（β2-MG）检测证实具有早期肾功能损害的轻、中度高血压患者，随机分为3组， 即伊贝沙坦组（A组,50例）：口服伊贝沙坦150~300 mg/d；依那普利组（B组,26例）：口服依那普利5~10 mg/d及伊贝沙坦加依那普利组（C组,34例）。所有入选病例均治疗12周，治疗前后测量血压并采用ELISA法检测血、尿中β2-MG的水平；采用彩色超声多普勒仪检查肾血流量及肾血管重构的情况。结果： 与治疗前相比较，治疗12周后3组患者的收缩压、舒张压均明显下降（P〈0.01）；血、尿中β2-MG的水平明显降低（P〈0.01）；肾阻力指数（RI）、搏动指数（PI）及平均流速（Vm）明显改善（P〈0.01）。治疗后肾血管管壁的厚度及肾动脉的内径与治疗前有显著性差异（P〈0.05）。伊贝沙坦与依那普利联合治疗组与单用伊贝沙坦或依那普利治疗组比较，血、尿中β2-MG的水平及肾血管重构指标有显著改善（P〈0.01或P〈0.05）。 结论： 伊贝沙坦与依那普利联用对有早期肾功能损害的高血压患者，不仅有明显的降压作用，而且有明显改善肾功能的作用。

AIM： To evaluate the efficacy and safety of the combination of irbesartan and enalapril in treating renal damage in hypertensive patients. METHODS： A total of 110 patients with essential hypertension （EH） complicated with mild renal insufficiency were included in this study. Fifty cases were treated with irbesartan （150-300 mg/day）, 26 cases were treated with enalapril （5-10 mg/day） and 34 cases were treated with a combination of irbesartan and enalapril for 12 weeks. Renal hemodynamics and structural variations and blood and urine microglobulin of β2-MG were determined before and after treatment by color Doppler ultrasonography and kit. RESULTS： After the combination treatment of irbesartan and enalapril, both systolic and diastolic pressure were significantly decreased （P〈0.01）. In groups A, B, and C, β2-MG in blood and urine were obviously decreased （P〈0.01） and RI, PI and Vm were markedly decreased in left and right kidney after treatment. Thickness of renal arterial wall was significantly decreased and the renal arterial diameter was obviously increased （P〈0.05）. Compared with those in group C, blood and urine microglobulin of β2-MG and RI, PI and Vm were markedly decreased in left and right kidney after treatment. CONCLUSION： Irbesartan combined with enalapril was effective in lowering blood pressure, decreasing the concentration of β2-MG in blood and urine, decreasing renal arterial vessel resistance, increasing renal blood flow and improving renal vessel structure, thus improving renal function.