氯沙坦治疗尿毒症血液透析病人高血压的临床研究

A COMPARISON OF THE EFFECTS OF LOSARTAN, BENAZEPRIL AND PRAZOSIN ON PATIENTS WITH UREMIA AND HYPERTENSION UNDERGOING HEMODIALYSIS

目的 观察氯沙坦对慢性肾衰竭尿毒症期并发高血压血液透析病人的血压及其尿蛋白、血尿酸和左心室功能影响。②方法 将 88例病人随机分为 3组 ,研究组采用氯沙坦 +硝苯地平 ,对照 1组采用苯钠普利 +硝苯地平 ,对照 2组采用哌唑嗪 +硝苯地平 ,共治疗 84d .定期检测动脉血压、尿蛋白、血尿酸以及左室舒张期内径。③结果 3组降压作用相当 (F =0 .2 5 1,P均 >0 .0 5 ) ,研究组和对照 1组尿蛋白较治疗前明显减少 (t =2 .75 9,2 .80 7,P均 <0 .0 1) ,研究组与对照 2组比较治疗后尿蛋白下降明显 (F =6 .5 45 ,q =2 .983,P <0 .0 1)。研究组和对照 1组左室舒张末期内径与治疗前比较明显缩小 (t=2 .36 4,2 .2 97,P均 <0 .0 5 ) ,研究组较对照 2组变化明显 (F =3.889,q =2 .5 74,P <0 .0 5 )。研究组用药后血尿酸降低明显 (t=2 .5 71,P <0 .0 5 ) ,与对照 1组和对照 2组比较差异有统计学意义 (F =4.12 3,q=2 .485 ,2 .5 6 1,P均 <0 .0 5 )。未发现肝功能恶化及骨髓抑制等不良反应。④结论氯沙坦降压效果好 ,副作用少 ,是治疗尿毒症血液透析病人高血压的理想药物。

Objective\ To observe the effects of losartan on blood pressure, uric acid, proteinuria and left ventricular function of patients with uremia and hypertension undergoing hemodialysis.\ Methods\ 88 patients were randomly divided into 3 groups. The treated group was given losartan plus nifedipine, the control group 1 benazopril plus nifedipine and those in control group 2, prazosin plus nifedipine. The duration of treatment for the 3 groups was the same, i.e. 84 days. The blood pressure, urine albumin, uric acid and left ventricular diastolic inner diameter were measured regularly.\ Results\ The blood pressure dropped similarly in the three groups( F=0.251,P >0.05). The urine albumin excretion for treated group decreased compared with the control group 1( t=2.759, 2.807,P <0.01). The albuminuria dropped markedly in treated group after treatment compared with the control group 2( F=6.545,q=2.983, P <0.01)and left ventricular diastolic inner diameter decreased both in the treated group and control group 1 ( t =2.364, 2.297, both P <0.05 ).The variations of treated group were obvious as compared with the control group 2( F=3.889,q=2.574, P <0.05). Uric acid reduced significantly after medication as compared with both control group 1 and control group 2 ( F=4.123,q =2.485, 2.561, both P <0.05). No deterioration of hepatic functions and marrow inhibition were found in the three groups.\ Conclusion\ Losartan is an ideal agent for patients with uremia and hypertension undergoing hemodialysis as it is good for antihypertension with few side effects.