培哚普利比硝苯地平能更有效降低高血压病患者的尿蛋白排泄

Greater reduction of urinary albumin excretion in hypertensive patients with perindopril than nifedipine

目的探讨硝苯地平和培哚普利长期治疗对高血压病患者肾功能的影响。方法５２例高血压病患者随机分为两组：硝苯地平组（２６例）和培哚普利组（２６例），疗程２４周，治疗前后观察肾功能指标变化。结果（１）两种药物能同等程度降低各组高血压病患者的动脉血压，但培哚普利组高血压病患者治疗后能显著降低尿蛋白的排泄量，升高肾小球滤过率［２４小时尿白蛋白（ｍｇ／２４ｈ）：１０４５±４１．８降至６６．７±２５．９，Ｐ＜０．０１；２４小时尿蛋白（ｇ／Ｌ）：０．２４±０．０６４降至０．１７±０．０３９，Ｐ＜００１；肾小球滤过率（ｍｌ／ｍｉｎ）：１１２．２±１３．２升至１２５．５±１５．２，Ｐ＜０．０５］，而硝苯地平组治疗前后无明显变化（Ｐ＞０．０５）。（２）两组治疗后尿白蛋白下降幅度与收缩压和舒张压下降幅度均无显著相关（ｒ值分别为：０．２６９和０．２７８，Ｐ＞０．０５，与０．１８２和０．１８８，Ｐ＞０．０５）。结论对高血压病合并早期肾损害患者，培哚普利比硝苯地平更有效地降低尿蛋白排泄；培哚普利减少尿白蛋白排泄是不依赖于动脉血压的有效降低，其可能机制是肾内血流量或肾小球通透性的改变所致。

Objective To examine the effect of perindopril and nifedipine on renal function in patients with essential hypertension (EH). Methods 52 cases with EH were divided randomly into two groups: perindopril group(4mg qd, n=26); nifedipine group(10 mg tid, n=26). Treatment period lasted for 24 weeks. Parameters of renal function were measured before and after treatment. Results (1) After treatment, the arterial pressure decreased in a similar way in the two groups, urinary albumin excretion was significantly less after treatment in the perindopril group <0.01;urine protein/24h(g/L):0.170.039 vs 0.240.064, P<0.01], GFR(ml/min) was higher in the perindopril group after treatment(125.515.2 vs 112.213.2,P<0.05). No significant changes were observed with nifedipine (P<0.05).(2) No significant correlation between the decrement of urinary albumin excretion and of SBP, DBP was found in both groups (P>0.05). Conclusion It is shown that perindopril, but not nifedipine, is able to reduce urinary excretion of albumin in patients with essential hypertension independently of its effective antihypertensive propeties. It is probable that the positive effect of perindopril on microalbuminuria is attributable to modification in intrarenal hemodynamics or to change in glomerular permeability.