不同剂量缬沙坦联合硝苯地平对糖尿病肾病伴高血压患者心肾功能及血管内皮功能的影响

Effects of Different Doses of Valsartan Combined with Nifedipine on Cardiac and Renal Functions and Vascular Endothelial Function in Patients with Diabetes Nephropathy and Hypertension

目的 观察不同剂量缬沙坦联合硝苯地平对糖尿病肾病伴高血压患者心肾功能及血管内皮功能的影响。方法 选择2021年10月至2022年10月收治的106例糖尿病肾病伴高血压患者,根据随机数字表法分为观察组与对照组,各53例,每组入院均给予缬沙坦联合硝苯地平治疗,其中对照组缬沙坦治疗剂量为80 mg/d,观察组缬沙坦治疗剂量为160 mg/d。比较两组患者治疗前后心功能[左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)]、肾功能[血尿素氮(BUN)、胱抑素C(CysC)、血肌酐(Scr)]及血管内皮功能[内皮素-1(ET-1)、一氧化氮(NO)]的变化,并对其不良反应发生情况进行客观性评价。结果 治疗前两组LVESD、LVEDD、BUN、CysC、Scr、ET-1、NO比较差异无统计学意义(P> 0.05),治疗后NO均升高(P <0.05),LVESD、LVEDD、BUN、CysC、Scr、ET-1均下降(P <0.05),且治疗后观察组各项指标改善效果均优于对照组(P <0.05);随访调查结果显示观察组并发症发生率13.21%略低于对照组的18.87%,但两组相比差异无统计学意义(P> 0.05)。结论 缬沙坦联合硝苯地平可有效治疗糖尿病肾病伴高血压,但与80 mg/d低剂量的缬沙坦相比,160 mg/d高剂量的缬沙坦在改善心肾功能,减轻血管内皮损伤上优势更明显。

Objective To observe the effects of different doses of valsartan combined with nifedipine on cardiac and renal functions and vascular endothelial functions in patients with diabetes nephropathy and hypertension.Methods A total of 106 patients with diabetes nephropathy and hypertension admitted to our hospital from October 2021 to October 2022.The patients were randomly divided into the observation group and the control group,with 53 patients in each group.Each group was treated with valsartan combined with nifedipine.The treatment dose of valsartan in the control group was 80 mg/d,and the treatment dose of valsartan in the observation group was 160 mg/d.Compare the changes in cardiac function [left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)],renal function [blood urea nitrogen(BUN),cystatin C(CysC),blood creatinine(Scr)],and vascular endothelial function [endothelin-1(ET-1),nitric oxide(NO)] before and after treatment between two groups of patients,and objectively evaluate the occurrence of adverse reactions.Results There was no significant difference in LVESD,LVEDD,BUN,CysC,Scr,ET-1,and NO between the two groups before treatment(P>0.05).After treatment,NO increased(P<0.05),while LVESD,LVEDD,BUN,CysC,Scr,and ET-1 decreased(P<0.05).Moreover,after treatment,the improvement effect of various indicators in the observation group was better than that in the control group(P<0.05);The follow-up survey results showed that the incidence of complications in the observation group was 13.21%,slightly lower than the control group's 18.87%,but there was no statistically significant difference between the two groups(P>0.05).Conclusions Valsartan combined with nifedipine can effectively treat diabetes nephropathy with hypertension,but compared with 80 mg/d low-dose valsartan,160 mg/d high-dose valsartan has more obvious advantages in improving heart and kidney functions and reducing vascular endothelial damage.