肾素-血管紧张素-醛固酮系统抑制剂单用或联合钙通道阻滞剂治疗门诊慢性肾脏病疗效比较:基于倾向性评分匹配的队列研究

Effect comparison of RAAS inhibitors monotherapy or combined with CCB in patients with CKD: A cohort study based on propensity score matching

目的探讨肾素-血管紧张素-醛固酮系统(RAAS)阻滞剂联用钙通道阻滞剂(CCB)与单用RAAS阻滞剂在四川大学华西医院门诊慢性肾脏病(CKD)患者中控制血压、保护肾脏的作用。方法纳入2012年12月至2015年11月四川大学华西医院门诊123例CKD患者。采用倾向性评分匹配(propensity score matchin,PSM),比较匹配后31对患者用药方案开始1年后收缩压、舒张压、血肌酐、估算肾小球滤过率(e GFR)、尿蛋白定性及定量结果、随访期间入院及高钾血症发生情况。结果两种用药在控制血压、控制血肌酐和e GFR、控制尿蛋白的疗效、患者入院、发生高钾血症情况差异均无统计学意义。结论 RAAS受体阻滞剂联用CCB与RAAS受体阻滞剂单药超单倍剂量在血压控制、肾脏保护效果、患者入院、高钾血症发生情况上差异均无统计学意义。

Objective This retrospective cohort compared blood pressure-controlling effect and renoprotective effect of combination of RAAS inhibitors with calcium channel blockers （CCB） and RAAS inhibitors monotherapy on patients with chronic kidney disease （CKD） in West China Hospital, Sichuan University. Methods Our retrospective cohort included 123 CKD patients from West China Hospital, Sichuan University; 81 were treated with RAAS inhibitors with CCB, and 42 were treated with RAAS inhibitors monotherapy. Using propensity score matching （PSM）, we compared the matched 3 lpairs＇ systolic and diastolic blood pressure, serum creatinine,estimated glomerlar filtration rate （eGFR）, 24h urinary protein, hospitalization and incidence of hyperkalmia after i year of treatments. Results There was no significant difference between the two treatments in controlling blood pressure, serum creatinine, urinary protein, hospitalization or incidence of hyperkalmia. Conclusion There is no significant difference between RAAS inhibitors with CCB and RAAS inhibitors monotherapy in controlling blood pressure, serum creatinine, urinary protein, hospitalization or incidence of hyperkalmia.