氯沙坦对原发性高血压伴高尿酸血症患者血清超敏C反应蛋白和尿酸浓度的影响

Effect of losartan on high sensitive C-reactive and uric acid of essential hypertensive patients with hyperuricemia

目的 探讨氯沙坦对原发性高血压伴高尿酸血症（HUA）患者血清超敏C反应蛋白（hsCRP）和尿酸（UA）的影响及其安全性.方法 将80例高血压伴HUA患者随机分为氯沙坦组（40例）和硝苯地平组（40例）,每组分别给予氯沙坦50 mg/d、硝苯地平控释片30 mg/d口服,连续治疗6个月,检测用药前、后血清hs-CRP、UA、肝肾功能、血肌酸磷酸激酶（CK）浓度及血压的变化.结果 与治疗前比较,治疗6个月后氯沙坦组与硝苯地平组的收缩压（SBP）、舒张压（DBP）均显著降低[氯沙坦组收缩压由（158.5±13.2） mmHg降至（136.7±9.4） mmHg,t=3.50,P＜ 0.01;舒张压由（95.6±8.4） mmHg降至（83.3±6.4） mmHg,t=3.49,P＜ 0.01;硝苯地平组收缩压：（157.7 ±13.9） mmHg降至（134.6±8.2）mmHg,t=3.53,P＜ 0.01;舒张压：（96.1 ±8.9）mmHg降至（81.2 ±6.8）mmHg,t=3.56,P＜ 0.01],但组间比较差异无统计学意义.氯沙坦组的血清hs-CRP、UA浓度较用药前明显下降,差异均有统计学意义[氯沙坦组hs-CRP：（5.68±1.53） mg/L降至（3.52±0.57） mg/L,t=3.82,P＜ 0.01;UA：（502 ±45）μmol/L降至（450 ±38） μmol/L,t=3.48,P＜0.01];而硝苯地平组血清hs-CRP、UA浓度较用药前无明显变化[血清hs-CRP：（5.61±1.64） mg/L降至（5.33±1.48） mg/L,t=1.34,P＞ 0.05;UA：（499 ±43）μmol/L降至（489 ±42） μmol/L,t=0.68,P＞ 0.05].氯沙坦组患者服药前后肝肾功能、CK的变化均无显著差异,未发生严重不良事件.结论 氯沙坦能降低原发性高血压伴HUA患者的血清hs-CRP、UA浓度,治疗期间无严重不良反应,安全性良好.

Objective To evaluate the influence and safety of losartan on high sensitive C-reactive protein（hs-CRP） and serum uric acid（UA） of essential high blood pressure（HBP） patients with hyperuricemia （HUA）.Methods Eighty HBP patients complicated with HUA were enrolled and divided into the losartan group with losartan 50 mg/d（n =40） and the nifedipine group with nifedipine gastrointestinal therapeutic system （GITS） 30 mg/d （n =40） for 6 months continuously.The serum levels of hs-CRP,UA,hepatic and renal functions,creatine kinase（CK） and blood pressure were measured.Results Compared with before therapy,the systolic blood pressure（SBP）,diastolic blood pressure （DBP） were lower in two groups after 6-month treatment and the differences were statistically significant（losartan group：SBP：（158.5 ± 13.2） mmHg vs.（136.7 ± 9.4） mmHg,t =3.50,P ＜ 0.01 ; DBP：（95.6 ± 8.4） mmHg vs.（83.3 ± 6.4） mmHg,t =3.49,P ＜ 0.01 ; nifedipine group：SBP：（157.7 ± 13.9） mmHg vs.（134.6 ± 8.2） mmHg,t =3.53,P ＜ 0.01 ; DBP：（96.1 ± 8.9） mmHg vs.（81.2±6.8） mmHg,t =3.56,P ＜0.01）.The differences in terms of systolic and diastolic blood pressure were not significant at post-treatment between losartan and nifedipine group.The serum levels of hs-CRP and UA were significantly lower after 6-month treatment than before treatment in losartan group （（5.68 ± 1.53） mg/L vs.（3.52 ± 0.57） mg/L,t =3.82,P ＜ 0.01 ; （502 ± 45） μmol/L vs.（450 ± 38） μmol /L,t =3.48,P＜ 0.01）,but there was no change in nifedipine group（hs-CRP：（5.61 ± 1.64） mg/L vs.（5.33 ± 1.48） mg/L,t =1.34,P ＞ 0.05 ; UA：（499 ± 43） μmol/L vs.（489 ± 42） μmol/L,t =0.68,P ＞ 0.05）.There was no significant change regarding of liver and kidney functions and serum CK in losartan group before and after treatment.No adverse reaction occurred in the losartan group.Conclusion Losartan treatment can decrease serum hs-CRP and UA of HBP patients complicated with HUA,and there is no serious adverse reactions and good security during treatment.