高剂量缬沙坦治疗慢性肾小球肾炎合并高血压的临床效果及对TGF-β1、MMP-9和TIMP-1的影响

Clinical Efficacy of High-dose Valsartan in Treatment of Patients with Hypertension Combined with Chronic Glomerulonephritis and Its Effects on TGF-β1,MMP-9 and TIMP-1

目的探讨高剂量缬沙坦治疗慢性肾小球肾炎(CGN)合并高血压的临床效果及对转化生长因子-β1(TGF-β1)、基质金属蛋白酶-9(MMP-9)和金属蛋白酶组织抑制剂-1(TIMP-1)的影响。方法选取2014年1月—2016年12月收治的128例CGN合并高血压患者作为研究对象,根据药物用量分为对照组(常规剂量缬沙坦)和研究组(高剂量缬沙坦),每组64例。两组均治疗3个月,比较两组治疗前后血压、肾功能、TGF-β1、MMP-9、TIMP-1和临床疗效,并记录不良反应的发生情况。结果两组治疗后收缩压和舒张压均较治疗前下降(P<0.05);对照组治疗后血肌酐较治疗前上升,肾小球滤过率较治疗前下降(P<0.05)。治疗后,研究组血肌酐低于对照组,肾小球滤过率高于对照组(P<0.05)。治疗后,两组TGF-β1、TIMP-1较治疗前降低,MMP-9较治疗前升高,且研究组降低和升高程度均明显大于对照组(P<0.05)。研究组临床总有效率明显高于对照组(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论高剂量缬沙坦治疗CGN合并高血压患者的临床效果显著,可能与降低TGF-β1和TIMP-1水平、升高MMP-9水平有关,且具有一定的安全性。

Objective To investigate clinical efficacy of high-dose Valsartan in treatment of patients with hypertension combined with chronic glomerulonephritis（ CGN） and its effects on transforming growth factor-β1（ TGF-β1）,matrix metalloproteinase-9（ MMP-9） and tissue inhibitor of metalloproteinase-1（ TIMP-1）. Methods A total of 128 patients with hypertension combined with CGN admitted during January 2014 and December 2016 were divided into control group（ n = 64,conventional dose of Valsartan） and study group（ n = 64,high dose of Valsartan） according to medication doses. All patients were treated for 3 months,and then blood pressure,renal function,TGF-β1,MMP-9,TIMP-1 and clinical efficacy were compared before and after treatment,and incidence conditions of adverse reactions were also recorded in two groups. Results Levels of systolic pressure and diastolic pressure after treatment were significantly lower than those before treatment in two groups（ P〈0. 05）. In control group,after treatment,level of blood creatinine was higher,while glomerular filtration rate was lower than those before treatment（ P〈0. 05）. After treatment,in study group,level of blood creatinine was significantly lower,while glomerular filtration rate was significantly higher than those in control group（ P〈0. 05）; TGF-β1 and TIMP-1 levels were significantly lower,while MMP-9 levels were significantly higher than those before treatment in two groups,and the change degrees in study group were significantly greater than those in control group（ P〈0. 05）. The total effective rate in study group was significantly higher than that in control group（ P〈0. 05）. There was no significant difference in incidence rate of adverse reactions between two groups（ P〈0. 05）. Conclusion High-dose Valsartan in treatment of patients with hypertension combined with chronic glomerulonephritis may achieve good clinical efficacy,and it may be related to reducing TGF-β1 and TIMP-1 levels and increasing MMP-9 level with a certain safety.