不同剂量阿托伐他汀对高血压早期肾损害患者肾脏保护作用

Renal protective effects of different dose atorvastatin on patients with early renal damage complicated by hypertension

目的观察不同剂量的阿托伐他汀对于高血压合并早期肾损害患者肾功能的影响。方法 120例患者随机分为4组,分别为小剂量他汀组、常规剂量他汀组、大剂量他汀组和对照组。前3组在规范服用降压药物基础上,分别加服阿托伐他汀钙片(美国辉瑞公司生产,单剂量20mg)10mg、20mg、40mg,每晚餐后1小时服用。对照组仅规范服降压药物常规治疗。疗程为6个月,其中治疗3个月时进行一次复查。在研究开始基线、3个月复查时,以及研究结束时均采集记录以下检验指标:丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酸激酶(CK)、尿素氮(BUN)、肌酐(Cr)、24小时尿微量白蛋白(mAlb);比较起始和试验结束时超声检测各组患者肾叶间动脉阻力指数(RI)。结果小剂量他汀组在治疗3个月时mAlb、RI水平较治疗前无明显改变,但到6个月时较治疗前有所下降。他汀治疗组mAlb、RI水平均较治疗前及对照组明显下降(P<0.05),且大剂量他汀组较常规剂量他汀组降低mAlb、RI更显著,常规剂量他汀组较小剂量他汀组降低mAlb、RI更显著(P<0.05)。随时间延长,作用更显著(P<0.05)。不良反应轻微。结论阿托伐他汀能显著降低mAlb、RI水平,可能具有剂量依赖性及时间依赖性。

Objective To observe the different doses of atorvastatin on renal function in patients with hypertension compliated with renal damage.Methods One hundred and twenty patients were randomly divided into four groups：low-dose statin group,conventional-dose statin group,high-dose statin group and control group.The first three groups on the basis of norms taking antihypertensive medications were given additional atorvastatin calcium（Pfizer production,single-dose 20mg）10mg,20mg,40mg,taking one hour postprandial night.Patients in control group were given antihypertensive drugs as conventional treatment.The course of treatment was six months.The patients were revisited after three months of treatemnt.At the beginning of the study,after three months of treatment and at the end of the study,the following indexes were collected：alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,creatine kinase（CK）,urea nitrogen（BUN）,creatinine（Cr）,24hour urinary micro albumin（mAlb）;comparison was made for the interlobar artery resistance index（RI）at the initiation and test at the end of ultrasound detection of renal patients.Results In low-dose group,at the three months revisit after treatment,mAlb,RI levels showed no significant difference in comparison with before treatment（P〉0.05）,but at the end of six months,the above two indexes decreased.mAlb and RI levels in statin group decreased more greatly than before treatment and that of control group（P〈 0.05）.The decrease was greater in high-dose statin group than in conventional-dose statin group,so it was the same with conventional-dose statin group and low-dose statin group.As the time went on,the reaction was more obvious（P〈 0.05）.Adverse reactions were mild.Conclusion Atorvastatin may decrease mAlb and RI levels in a dose and time-dependent manner.