阿托伐他汀对高血压合并高低密度脂蛋白胆固醇血症患者肾功能的影响

The effect of atorvastatin on renal function in hypertensive patients with hyper-low-density-lipoprotein-cholesterolemia

目的探讨阿托伐他汀对高血压合并高低密度脂蛋白胆固醇(LDL-C)血症患者肾功能的影响。方法选择2013年6月至2014年12月福建省立医院老年科、心内科门诊和住院治疗的1、2级高血压合并高LDL-C血症患者154例,随机分为单纯降压组[78例,给予苯磺酸氨氯地平(5mg/d)降压治疗]和联合降压组[76例,在单纯降压治疗基础上加用阿托伐他汀(20mg/d)治疗],随访半年,观察两组治疗前后血压、估算的肾小球滤过率(eGFR)、尿微量白蛋白、LDL-C水平的变化情况。结果双因素重复测量方差分析显示,两组治疗前后血压的组间效应和交互效应差异无统计学意义(均P>0.05),而组内效应差异有统计学意义(均P<0.01)。与单纯降压组比较,联合降压组eGFR差值[(12.28±5.01)比(6.19±3.57)mL/(min·1.73 m^2)]、尿微量白蛋白差值[(28.65±13.97)比(21.36±13.62)mg/L]、LDL-C差值[(1.42±0.57)比(0.35±0.71)mmol/L]较大(均P<0.01)。多元线性回归分析结果显示,他汀类药物治疗和血压差值是治疗前后eGFR变化(B=5.23、0.10)和尿微量白蛋白变化(B=-6.03、-0.87;均P<0.01)的独立影响因素。结论阿托伐他汀对高血压合并高LDL-C血症患者具有独立于降脂作用之外的肾功能保护作用。

Objective To investigate the effect of atorvastatin on renal function in hypertensive patients with hyperlow-density-lipoprotein-cholesterolemia（LDL-C）. Methods Between June 2013 and December 2014,a total of 154 level 1and 2hypertensive patients with hyper-low-density-lipoprotein-cholesterolemia who were outpatients or inpatients from Department of Geriatric Medicine and Cardiology of Fujian Provincial Hospital were randomly divided into single lower blood pressure treatment group [n=78,receiving amlodipine besylate（5 mg/d）for six months]and combined lower blood pressure treatment group [n=76,receiving amlodipine besylate（5 mg/d）and atorvastatin（20mg/d）for six months].Blood pressure was measured,and the estimated glomerular filtration rate（eGFR）,urinary microalbumin and LDL-C were determined before and after treatment in both groups. Results Two-factor repeated measures analysis of variance showed that there were no differences in between-group effect and interaction effect of blood pressure（all P〉0.05）,while there were significant differences in intra-group effect of blood pressure（all P〈0.01）between the two groups before and after treatment. The changes of levels of eGFR [（12.28±5.01）vs（6.19±3.57）mL/（min·1.73m^2）],urinary microalbumin[（28.65±13.97）vs（21.36±13.62）mg/L]and LDL-C[（1.42±0.57）vs（0.35±0.71）mmol/L]were significantly more in combined lower blood pressure treatment group than those in single lower blood pressure treatment group before and after treatment（all P 0.01）.Multivariate linear regression analysis showed that treatment with atorvastatin and the change of blood pressure were independent influencing factors for the change of eGFR（B=5.23,0.10,P〈0.01）and the change of urinary microalbumin（B=-6.03,-0.87,all P〈0.01）before and after treatment. Conclusion Atorvastatin had a renoprotective effect independent of lipid-lowering effect in hypertensive patients with hyper-LDL-C.