综合管理模式对社区高血压合并肾脏损害的干预效果研究

目的探究对社区高血压合并肾脏损害患者应用综合管理模式干预的效果。方法选取400例社区高血压合并肾脏损害患者,使用计算机抽号分为对照组和观察组,每组200例。对照组使用一般模式干预,观察组使用综合管理模式干预。比较两组患者高血压相关知识知晓率、血压达标率、服药依从性、家庭血压自测率,干预前后血压(舒张压、收缩压)、血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、血糖(空腹血糖)、肾功能指标(尿素氮、肌酐)、尿微量白蛋白、尿蛋白水平,临床效果。结果观察组患者高血压相关知识知晓率92.50%、血压达标率66.50%、服药依从性94.00%、家庭血压自测率80.00%均高于对照组的80.00%、52.00%、79.50%、61.50%,差异具有统计学意义(P<0.05)。干预后,观察组患者的舒张压(78.28±8.97)mm Hg(1 mm Hg=0.133 kPa)、收缩压(131.11±10.02)mm Hg、TC(3.24±1.01)mmol/L、TG(1.01±0.54)mmol/L、LDL-C(3.01±0.32)mmol/L、HDL-C(1.72±0.79)mmol/L、空腹血糖(6.64±1.42)mmol/L、尿素氮(6.02±1.01)mmol/L、肌酐(76.34±10.29)μmol/L、尿微量白蛋白(0.64±0.11)mg/L、尿蛋白(10.34±1.37)mg/L均优于对照组的(85.67±9.13)mm Hg、(146.71±10.96)mm Hg、(4.36±1.07)mmol/L、(1.46±0.43)mmol/L、(4.65±0.47)mmol/L、(1.56±0.52)mmol/L、(7.12±1.67)mmol/L、(7.78±1.21)mmol/L、(96.24±17.38)μmol/L、(1.53±0.36)mg/L、(15.46±3.23)mg/L,差异具有统计学意义(P<0.05)。观察组患者临床总有效率94.00%高于对照组的74.00%,差异具有统计学意义(P<0.05)。结论综合管理模式干预用于社区高血压合并肾脏损害患者的效果良好,可有效提高患者高血压相关知识知晓度,提升服药依从性,改善患者血压、血脂、血糖水平,利于患者身体康复,值得大力推广应用。

冬虫夏草制剂对自发性高血压大鼠肾组织ICAM-1和VCAM-1表达的影响

目的:观察自发性高血压大鼠(SHR)肾组织中细胞间黏附分子-1(ICAM-1)和血管细胞黏附分子-1(VCAM-1)表达及冬虫夏草制剂对其影响。方法:清洁级雄性SHR22只、WKY大鼠6只(W组),SHR随机分为非干预组(S组)、冬虫夏草制剂组(C组)、福辛普利组(F组)、冬虫夏草制剂加福辛普利组(FC组),后3组以冬虫夏草制剂4g/(kg.d)和/或福辛普利10mg/(kg.d)灌胃,S组及W组以等量清水灌胃,测血压,8周末测尿蛋白、血肌酐,取肾组织做HE,Masson染色,免疫组织化学及RT-PCR方法检测ICAM-1,VCAM-1蛋白及mRNA表达情况。结果:与WKY大鼠比较,SHR尿蛋白排泄量增高,肾组织ICAM-1,VCAM-1蛋白及mRNA表达增强。与S组比较,福辛普利使大鼠血压下降,而冬虫夏草制剂无明显降压作用。但C,F,FC组均有尿蛋白排泄量、血肌酐水平下降;肾组织ICAM-1,VCAM-1蛋白及mRNA表达下调。结论:高血压造成肾脏损害时可出现肾组织ICAM-1和VCAM-1的异常表达,冬虫夏草制剂可有效改善二者的异常表达,具有良好的肾保护作用。

Endothelin receptor antagonist combined with a calcium channel blocker attenuates renal injury in spontaneous hypertensive rats with diabetes

OBJECTIVE: To investigate the effects of the mixed endothelin receptor antagonist, bosentan, combined with the long-acting calcium channel blocker, amlodipine, compared to the angiotensin-converting enzyme inhibitor, cilazapril, on the progressive renal injury in spontaneous hypertensive rats (SHR) with diabetes. METHODS: Diabetic hypertensive rats (SHR-DM) were induced by streptozotozin injected in male SHR (7-week-old),and divided into an untreated and three treated groups: 1) cilazapril treated group; 2) bosentan+amlodipine treated group; and 3) amlodipine treated group. Wistar Kyoto rats (WKY) and SHR rats served as normotensive and hypertensive control, respectively. The mean arterial blood pressure, renal function, endothelin and angiotensin II levels as well as the protein expression of renal extracellular matrix components and transforming growth factor (TGF)-beta1 were determined at the end of the 4th week. RESULTS: Mean arterial blood pressure significantly increased in SHR and SHR-DM rats compared to WKY rats. All the therapies reduced the blood pressure to normal levels. However, the enhanced urinary protein excretion, the decreased creatinine clearance as well as the increased plasma and intrarenal endothelin and angiotens in II levels were found in the untreated SHR-DM and prevented by treatment with bosentan+amlodipine and cilazapril. Similarly, these two kinds of therapies in SHR-DM abolished the overexpression of renal TGF-beta1 by Western blot analysis and reduced the accumulation of collagen type IV, laminin and fibronectin proteins by an immunochemical approach. Amlodipine monotherapy had no detectable effects on the above parameters. CONCLUSION: Bosentan combined with amlodipine can offer similar renoprotective effects on that of cilazapril and may be a potent therapy to attenuate renal injury by reducing renal protein levels of TGF-beta1 in diabetes with a hypertensive state.