Background: Hypertension (HTN) is present in up to 90% of end stage kidney disease (ESRD) patients irrespective of the etiology of their kidney disease. Moreover, it is an important modifiable risk factor for progress...Background: Hypertension (HTN) is present in up to 90% of end stage kidney disease (ESRD) patients irrespective of the etiology of their kidney disease. Moreover, it is an important modifiable risk factor for progression to ESRD and its overall cardiovascular morbidity and mortality. Objective: to evaluate, prospectively, the role of Renin-Angiotensin-Aldosterone System blockade (RAAS) in HTN, resistant to 3 conventional antihypertensives, in patients on maintenance hemodialysis (MHD). Patients and methods: A total of 52 such patients were treated with Ramipril and 5 with Losartan after intolerable cough/shortness of breath following Ramipril-use. None of the patients had fluid depletion, renal artery stenosis and primary endocrinopathy. The study group was compared to a matched control group of MHD patients with normal blood pressure following 3 drugs-combination therapies. Results: All patients, with resistant HTN, had significant activation of RAAS system prior to treatment compared to inactive one in the control group. In those with resistant HTN, control of HTN, was established within 2 weeks of therapy and was associated with suppression of the RAAS. Such therapy was associated with minor side effects. Conclusion: Our study has shown that RAAS blockade is safe and effective in controlling such resistant HTN in MHD patients.展开更多
目的了解中国中西部城市急性心肌梗死(AMI)患者血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)的使用情况,并探讨其影响因素。方法采用两阶段随机抽样抽取中西部城市31家医院2001年、2006年、2011年的AMI患者病历,收集和提...目的了解中国中西部城市急性心肌梗死(AMI)患者血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)的使用情况,并探讨其影响因素。方法采用两阶段随机抽样抽取中西部城市31家医院2001年、2006年、2011年的AMI患者病历,收集和提取相关资料,分析ACEI/ARB的使用情况以及使用的影响因素。结果共入选3044例患者,其中中国指南Ⅰ类推荐2951例,指南Ⅱa类推荐93例。2001年、2006年和2011年,指南Ⅰ类推荐患者ACEI/ARB使用情况为240(71.43%)、598(73.19%)、1230(68.41%);指南Ⅱa类推荐患者为4(57.14%)、5(62.50%)和37(47.44%)。在3个研究年份中,ACEI使用率均显著高于ARB(71.13%vs.0.60%;71.36%vs.2.57%;57.23%vs.11.79%),差异有统计学意义(P均<0.05)。多因素分析显示,与对应组相比,合并高血压(OR=2.37,95%CI:1.89~2.98)、糖尿病(OR=1.32,95%CI:1.02~1.70),心力衰竭病史(OR=1.65,95%CI:1.29~2.12),年龄≥75岁(OR=1.49,95%CI:1.14~1.95),入院时收缩压≥140 mm Hg(OR=1.94,95%CI:1.55~2.43),肾小球滤过率未测量(OR=4.10,95%CI:2.66~6.33)的患者更倾向于使用ACEI/ARB。女性(OR=0.77,95%CI:0.63~0.94)、非前壁ST段抬高型心肌梗死(OR=0.69,95%CI:0.59~0.82)、左室射血分数未测量(OR=0.47,95%CI:0.36~0.61)、有中风史(OR=0.73,95%CI:0.57~0.95)、合并慢性肾功能不全(OR=0.44,95%CI:0.20~0.95)的患者较少使用ACEI/ARB。结论中西部城市AMI患者中,指南I类推荐的患者约1/3住院期间未接受ACEI/ARB类药物治疗,且10年间该类药物的应用无明显改善。基于指南强烈推荐,AMI患者需增加ACEI/ARB类药物的应用。展开更多
目的评价银杏达莫联合血管紧张素Ⅱ受体拮抗剂(angiotensin II receptor blockers,ARB)对糖尿病肾病的治疗效应。方法检索国内外公开发表的有银杏达莫与ARB联合治疗糖尿病肾病的随机对照试验(RCT),采用Cochrane系统评价手册进行质量评价...目的评价银杏达莫联合血管紧张素Ⅱ受体拮抗剂(angiotensin II receptor blockers,ARB)对糖尿病肾病的治疗效应。方法检索国内外公开发表的有银杏达莫与ARB联合治疗糖尿病肾病的随机对照试验(RCT),采用Cochrane系统评价手册进行质量评价,用RevMan 5.1.4软件进行Meta分析。结果共纳入9项研究分析,银杏达莫与ARB联合用药治疗组在降低尿微量白蛋白排泄率(UAER)、24h尿蛋白、尿白蛋白(U-Alb)、血肌酐(SCr)、血纤维蛋白原等临床指标疗效优于单用ARB组(P<0.05),但在降低尿素氮(BUN)、血甘油三酯(TG)以及胆固醇(TC)以及血浆粘度等指标上差异无统计学意义(P>0.05)。结论银杏达莫与ARB联合用药对早期糖尿病肾病有一定疗效,但由于现有研究样本数较少,文献质量存在一定方法学问题,尚需要严格设计的大样本的RCT加以证实。展开更多
目的观察雷公藤多苷片治疗IgA肾病蛋白尿的临床疗效及安全性。方法选取2016年10月—2019年9月期间就诊于中国中医科学院西苑医院门诊的IgA肾病患者62例,按照是否接受雷公藤多苷片治疗分为观察组和对照组,每组各31例。对照组给予常规剂...目的观察雷公藤多苷片治疗IgA肾病蛋白尿的临床疗效及安全性。方法选取2016年10月—2019年9月期间就诊于中国中医科学院西苑医院门诊的IgA肾病患者62例,按照是否接受雷公藤多苷片治疗分为观察组和对照组,每组各31例。对照组给予常规剂量的血管紧张素转化酶抑制剂(Angiotensin-Converting Enzyme Inhibitor,ACEI)或血管紧张素受体拮抗剂(Angiotensin II Receptor Blocker,ARB)治疗,观察组在常规ACEI/ARB治疗的基础上加用雷公藤多苷片。治疗3个月后,观察比较两组患者治疗前后24 h尿蛋白定量(24 h U-TP)、肾功能指标[血肌酐(Serum Creatinine,Scr)、GFR]、肝功能指标[谷丙转氨酶(Alanine Aminotransferase,ALT)、谷草转氨酶(Aspartate Aminotransferase,AST)]、血常规指标[白细胞(White Blood Cells,WBC)、血红蛋白(Hemoglobin,HGB)、血小板(Platelet,PLT)]及临床疗效。结果治疗后对照组Scr较治疗前降低,GFR较治疗前升高,差异有统计学意义(P<0.05);观察组患者24 h U-TP、Scr均较治疗前明显降低,GFR较治疗前升高,差异有统计学意义(P<0.05);且观察组24 h U-TP治疗前后差值改善明显优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者ALT、AST指标与治疗前比较,差异无统计学意义(P>0.05)。治疗后两组患者WBC、HGB、PLT水平与治疗前比较,差异无统计学意义(P>0.05)。治疗后观察组总有效率83.87%(26/31)明显高于对照组总有效率54.84%(17/31),差异有统计学意义(P<0.05)。治疗期间两组患者均未发生骨髓抑制。结论雷公藤多苷片联合ACEI/ARB,可安全有效降低IgA肾病患者蛋白尿水平,改善患者肾功能。展开更多
Purpose: Local activation of rennin-angiotensin system (RAS) is involved in the progression of chronic kidney disease (CKD). One of the RAS components, angiotensinogen (AGT) has been known to be a potential surrogate ...Purpose: Local activation of rennin-angiotensin system (RAS) is involved in the progression of chronic kidney disease (CKD). One of the RAS components, angiotensinogen (AGT) has been known to be a potential surrogate biomarker for the renal RAS activity. Measuring the daily urinary excretion of AGT (U-AGT), the present study addressed whether the intensive blood pressure (BP) lowering with combined antihypertensive agents could improve such an abnormality in diabetic CKD patients. Methods: Uncontrolled hypertensive patients with type 2 diabetes with mild to moderate nephropathy previously receiving angiotensin receptor blockers (ARB) in an optimal dose alone were recruited for a better blood pressure (BP) control. Urinary specimens were subjected to a quantitative measurement of a daily urinary protein (U-prot) and U-AGT. After the baseline measurement, intensive antihypertensive therapy was attempted by switching the ARB dose to a fixed combination formula of candesartan 8 mg plus hydrochlorthiazide (HCTZ) 6.25 mg and the patients were followed up for 24 weeks. Comparison of parameters was then made between the values at the baseline and the end of the study. Results: At baseline, there was a significant positive correlation between U-AGT and U-prot, and between U-AGT and serum creatinine (Cr) concentration. In addition, U-AGT was inversely correlated with estimated glomerular filtration rate (e-GFR). Switching the antihypertensive regime from ARB alone to the combined ARB/HCTZ significantly reduced BP, U-AGT and U-prot. The magnitude of the reduction in U-prot was positively correlated with that in U-AGT. A stepwise regression analysis showed that HbA1c, e-GFR and the reduction in U-prot in response to the intensive antihypertensive therapy were positively correlated with the reduction in U-AGT. Conclusion: U-AGT is increased and positively correlated with U-prot in patients with type 2 diabetic nephropathy. Intensive antihypertensive treatment with ARB combined with HCTZ reduces both U-AGT and U-prot, presumably via an amelioration of an accelerated renal RAS activity. These data also suggest that U-AGT can be used as a potential therapeutic surrogate biomarker for the activated renal RAS in patients with diabetic nephropathy.展开更多
目的观察糖代谢基因Akt、Glut4在心肌梗死大鼠中的表达及血管紧张素受体抑制剂厄贝沙坦对其的影响。方法结扎雄性Wistar大鼠左冠状动脉制备心肌梗死模型,随机分为AMI组(n=6),假手术组(n=6),厄贝沙坦治疗组(n=6)和假手术治疗组(n=6),8周...目的观察糖代谢基因Akt、Glut4在心肌梗死大鼠中的表达及血管紧张素受体抑制剂厄贝沙坦对其的影响。方法结扎雄性Wistar大鼠左冠状动脉制备心肌梗死模型,随机分为AMI组(n=6),假手术组(n=6),厄贝沙坦治疗组(n=6)和假手术治疗组(n=6),8周后超声心动图评价心功能,采用Realtime PCR和Western Blot测定mRNA和蛋白水平表达。结果AMI组与假手术组比较,AMI组Glut4 mRNA水平及蛋白水平表达均增加(分别为155．9±9．4 vs 100．0±10．9,142．1±11．8 vs 100．0±12．1,P＜0．05),磷酸化Akt也增高(185．8±11．9 vs 100．0±10．2,P＜0．05),而经厄贝沙坦治疗后Glut4 mRNA和蛋白水平表达均降低(分别为155．9±9．4 vs 113．1±8．4,142．1±11．8 vs 112．1±16．9,P＜0．05),磷酸化Akt表达也降低(185．8±11．9 vs 135．5±19．6,P＜0．05)。结论心肌梗死后心肌缺血影响糖代谢基因Akt、Glut4的表达,厄贝沙坦可能通过改善心肌能量代谢起到对缺血心肌的保护性作用。展开更多
文摘Background: Hypertension (HTN) is present in up to 90% of end stage kidney disease (ESRD) patients irrespective of the etiology of their kidney disease. Moreover, it is an important modifiable risk factor for progression to ESRD and its overall cardiovascular morbidity and mortality. Objective: to evaluate, prospectively, the role of Renin-Angiotensin-Aldosterone System blockade (RAAS) in HTN, resistant to 3 conventional antihypertensives, in patients on maintenance hemodialysis (MHD). Patients and methods: A total of 52 such patients were treated with Ramipril and 5 with Losartan after intolerable cough/shortness of breath following Ramipril-use. None of the patients had fluid depletion, renal artery stenosis and primary endocrinopathy. The study group was compared to a matched control group of MHD patients with normal blood pressure following 3 drugs-combination therapies. Results: All patients, with resistant HTN, had significant activation of RAAS system prior to treatment compared to inactive one in the control group. In those with resistant HTN, control of HTN, was established within 2 weeks of therapy and was associated with suppression of the RAAS. Such therapy was associated with minor side effects. Conclusion: Our study has shown that RAAS blockade is safe and effective in controlling such resistant HTN in MHD patients.
文摘目的了解中国中西部城市急性心肌梗死(AMI)患者血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)的使用情况,并探讨其影响因素。方法采用两阶段随机抽样抽取中西部城市31家医院2001年、2006年、2011年的AMI患者病历,收集和提取相关资料,分析ACEI/ARB的使用情况以及使用的影响因素。结果共入选3044例患者,其中中国指南Ⅰ类推荐2951例,指南Ⅱa类推荐93例。2001年、2006年和2011年,指南Ⅰ类推荐患者ACEI/ARB使用情况为240(71.43%)、598(73.19%)、1230(68.41%);指南Ⅱa类推荐患者为4(57.14%)、5(62.50%)和37(47.44%)。在3个研究年份中,ACEI使用率均显著高于ARB(71.13%vs.0.60%;71.36%vs.2.57%;57.23%vs.11.79%),差异有统计学意义(P均<0.05)。多因素分析显示,与对应组相比,合并高血压(OR=2.37,95%CI:1.89~2.98)、糖尿病(OR=1.32,95%CI:1.02~1.70),心力衰竭病史(OR=1.65,95%CI:1.29~2.12),年龄≥75岁(OR=1.49,95%CI:1.14~1.95),入院时收缩压≥140 mm Hg(OR=1.94,95%CI:1.55~2.43),肾小球滤过率未测量(OR=4.10,95%CI:2.66~6.33)的患者更倾向于使用ACEI/ARB。女性(OR=0.77,95%CI:0.63~0.94)、非前壁ST段抬高型心肌梗死(OR=0.69,95%CI:0.59~0.82)、左室射血分数未测量(OR=0.47,95%CI:0.36~0.61)、有中风史(OR=0.73,95%CI:0.57~0.95)、合并慢性肾功能不全(OR=0.44,95%CI:0.20~0.95)的患者较少使用ACEI/ARB。结论中西部城市AMI患者中,指南I类推荐的患者约1/3住院期间未接受ACEI/ARB类药物治疗,且10年间该类药物的应用无明显改善。基于指南强烈推荐,AMI患者需增加ACEI/ARB类药物的应用。
文摘目的评价银杏达莫联合血管紧张素Ⅱ受体拮抗剂(angiotensin II receptor blockers,ARB)对糖尿病肾病的治疗效应。方法检索国内外公开发表的有银杏达莫与ARB联合治疗糖尿病肾病的随机对照试验(RCT),采用Cochrane系统评价手册进行质量评价,用RevMan 5.1.4软件进行Meta分析。结果共纳入9项研究分析,银杏达莫与ARB联合用药治疗组在降低尿微量白蛋白排泄率(UAER)、24h尿蛋白、尿白蛋白(U-Alb)、血肌酐(SCr)、血纤维蛋白原等临床指标疗效优于单用ARB组(P<0.05),但在降低尿素氮(BUN)、血甘油三酯(TG)以及胆固醇(TC)以及血浆粘度等指标上差异无统计学意义(P>0.05)。结论银杏达莫与ARB联合用药对早期糖尿病肾病有一定疗效,但由于现有研究样本数较少,文献质量存在一定方法学问题,尚需要严格设计的大样本的RCT加以证实。
文摘目的观察雷公藤多苷片治疗IgA肾病蛋白尿的临床疗效及安全性。方法选取2016年10月—2019年9月期间就诊于中国中医科学院西苑医院门诊的IgA肾病患者62例,按照是否接受雷公藤多苷片治疗分为观察组和对照组,每组各31例。对照组给予常规剂量的血管紧张素转化酶抑制剂(Angiotensin-Converting Enzyme Inhibitor,ACEI)或血管紧张素受体拮抗剂(Angiotensin II Receptor Blocker,ARB)治疗,观察组在常规ACEI/ARB治疗的基础上加用雷公藤多苷片。治疗3个月后,观察比较两组患者治疗前后24 h尿蛋白定量(24 h U-TP)、肾功能指标[血肌酐(Serum Creatinine,Scr)、GFR]、肝功能指标[谷丙转氨酶(Alanine Aminotransferase,ALT)、谷草转氨酶(Aspartate Aminotransferase,AST)]、血常规指标[白细胞(White Blood Cells,WBC)、血红蛋白(Hemoglobin,HGB)、血小板(Platelet,PLT)]及临床疗效。结果治疗后对照组Scr较治疗前降低,GFR较治疗前升高,差异有统计学意义(P<0.05);观察组患者24 h U-TP、Scr均较治疗前明显降低,GFR较治疗前升高,差异有统计学意义(P<0.05);且观察组24 h U-TP治疗前后差值改善明显优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者ALT、AST指标与治疗前比较,差异无统计学意义(P>0.05)。治疗后两组患者WBC、HGB、PLT水平与治疗前比较,差异无统计学意义(P>0.05)。治疗后观察组总有效率83.87%(26/31)明显高于对照组总有效率54.84%(17/31),差异有统计学意义(P<0.05)。治疗期间两组患者均未发生骨髓抑制。结论雷公藤多苷片联合ACEI/ARB,可安全有效降低IgA肾病患者蛋白尿水平,改善患者肾功能。
文摘Purpose: Local activation of rennin-angiotensin system (RAS) is involved in the progression of chronic kidney disease (CKD). One of the RAS components, angiotensinogen (AGT) has been known to be a potential surrogate biomarker for the renal RAS activity. Measuring the daily urinary excretion of AGT (U-AGT), the present study addressed whether the intensive blood pressure (BP) lowering with combined antihypertensive agents could improve such an abnormality in diabetic CKD patients. Methods: Uncontrolled hypertensive patients with type 2 diabetes with mild to moderate nephropathy previously receiving angiotensin receptor blockers (ARB) in an optimal dose alone were recruited for a better blood pressure (BP) control. Urinary specimens were subjected to a quantitative measurement of a daily urinary protein (U-prot) and U-AGT. After the baseline measurement, intensive antihypertensive therapy was attempted by switching the ARB dose to a fixed combination formula of candesartan 8 mg plus hydrochlorthiazide (HCTZ) 6.25 mg and the patients were followed up for 24 weeks. Comparison of parameters was then made between the values at the baseline and the end of the study. Results: At baseline, there was a significant positive correlation between U-AGT and U-prot, and between U-AGT and serum creatinine (Cr) concentration. In addition, U-AGT was inversely correlated with estimated glomerular filtration rate (e-GFR). Switching the antihypertensive regime from ARB alone to the combined ARB/HCTZ significantly reduced BP, U-AGT and U-prot. The magnitude of the reduction in U-prot was positively correlated with that in U-AGT. A stepwise regression analysis showed that HbA1c, e-GFR and the reduction in U-prot in response to the intensive antihypertensive therapy were positively correlated with the reduction in U-AGT. Conclusion: U-AGT is increased and positively correlated with U-prot in patients with type 2 diabetic nephropathy. Intensive antihypertensive treatment with ARB combined with HCTZ reduces both U-AGT and U-prot, presumably via an amelioration of an accelerated renal RAS activity. These data also suggest that U-AGT can be used as a potential therapeutic surrogate biomarker for the activated renal RAS in patients with diabetic nephropathy.
文摘目的观察糖代谢基因Akt、Glut4在心肌梗死大鼠中的表达及血管紧张素受体抑制剂厄贝沙坦对其的影响。方法结扎雄性Wistar大鼠左冠状动脉制备心肌梗死模型,随机分为AMI组(n=6),假手术组(n=6),厄贝沙坦治疗组(n=6)和假手术治疗组(n=6),8周后超声心动图评价心功能,采用Realtime PCR和Western Blot测定mRNA和蛋白水平表达。结果AMI组与假手术组比较,AMI组Glut4 mRNA水平及蛋白水平表达均增加(分别为155．9±9．4 vs 100．0±10．9,142．1±11．8 vs 100．0±12．1,P＜0．05),磷酸化Akt也增高(185．8±11．9 vs 100．0±10．2,P＜0．05),而经厄贝沙坦治疗后Glut4 mRNA和蛋白水平表达均降低(分别为155．9±9．4 vs 113．1±8．4,142．1±11．8 vs 112．1±16．9,P＜0．05),磷酸化Akt表达也降低(185．8±11．9 vs 135．5±19．6,P＜0．05)。结论心肌梗死后心肌缺血影响糖代谢基因Akt、Glut4的表达,厄贝沙坦可能通过改善心肌能量代谢起到对缺血心肌的保护性作用。
