不同治疗选择对恶性高血压患者预后的影响

Effect of Different Treatment Strategies on the Prognosis of Malignant Hypertension Patients

目的:探究恶性高血压患者的最佳治疗方法,以最大限度改善肾脏预后。方法:利用医渡云大数据系统回顾性分析2010年6月至2020年6月在青岛大学附属医院诊断为恶性高血压的患者,将其分为使用肾素血管紧张素系统抑制剂(Renin-Angiotensin System Inhibitor, RASI)治疗组及非RASI治疗组,最长追溯4年,分析两组患者的治疗反应,评价患者肾脏预后。结果:使用RASI治疗恶性高血压患者,在连续治疗6个月后,血清肌酐水平明显低于治疗前,随着治疗时间延长,预后进一步改善;对于血清肌酐在短时间内急剧升高需要启动急症透析的患者,腹膜透析在改善预后方面好于血液透析,但由于病例数较少,治疗效果通过校正卡方检验无显著性差异(P = 0.133)。生存分析进一步证实使用RASI并同时血压控制达标更加有利于肾脏预后。结论:RASI为治疗恶性高血压患者的首选药物,治疗时间越长,疗效越好。对肾功能急剧恶化需要启动透析治疗的患者,腹膜透析联合RASI治疗,脱离透析的可能性较血液透析更大。

Objective: To investigate the optimal treatment for patients with malignant hypertension in order to maximize renal prognosis. Methods: To retrospectively analyze patients diagnosed with malignant hypertension at the Affiliated Hospital of Qingdao University from June 2010 to June 2020 using the MeduCloud big data system, and divide them into the group treated with rennin-angiotensin system inhibitor (RASI) and the non-RASI treatment group with a maximum retrospective period of 4 years. The response to treatment in both groups was analyzed and the patients’ renal prognosis was evaluated. Results: In patients with malignant hypertension treated with RASI, serum creatinine levels were significantly lower than before treatment after 6 months of continuous treatment, and the prognosis further improved with longer treatment time;for patients whose serum creatinine increased sharply in a short period of time and required initiation of acute dialysis, peritoneal dialysis was better than hemodialysis in improving prognosis, but the treatment effect was not significant by corrected chi-square test due to the small number of cases (P = 0.133). Survival analysis further confirmed that the use of RASI with concomitant blood pressure control was more beneficial for renal prognosis. Conclusion: RASI is the drug of choice for the treatment of patients with malignant hypertension, and the longer the duration of treatment, the better the outcome. In patients with rapidly deteriorating renal function requiring initiation of dialysis treatment, peritoneal dialysis combined with RASI treatment is more likely to result in a greater likelihood of discharge from dialysis than hemodialysis.