氯沙坦聯(lián)合螺內(nèi)酯對腹膜透析患者殘余腎功能及腹膜功能的影響
發(fā)布時間：2019-06-08 11:50
【摘要】：背景：殘余腎功能和腹膜功能是影響腹膜透析患者生存率和技術(shù)生存率的重要因素。。腎素-血管緊張素-醛固酮系統(tǒng)激活參與腎臟病進展以及腹膜結(jié)構(gòu)和功能的改變,其中血管緊張素Ⅱ、醛固酮是重要的作用因素。血管緊張素受體拮抗劑對于腹膜透析患者殘余腎功能和腹膜功能的保護作用已經(jīng)得到研究證實。然而長期應(yīng)用血管緊張素受體拮抗劑時,醛固酮水平不能保持穩(wěn)定持續(xù)的降低,即出現(xiàn)“醛固酮逃逸”現(xiàn)象,提示醛固酮受體拮抗劑的加入可能發(fā)揮有益的保護作用。 目的：觀察血管緊張素受體拮抗劑氯沙坦、醛固酮拮抗劑螺內(nèi)酯單用及二者聯(lián)用對腹膜透析患者殘余腎功能及腹膜功能的影響,對比干預(yù)腎素-血管緊張素-醛固酮系統(tǒng)不同環(huán)節(jié)的作用差異,探索延緩腹膜透析患者殘余腎功能下降,保護腹膜功能的新方案,改善腹膜透析患者預(yù)后。 方法：以我院2010年3月至2013年3月規(guī)律行腹膜透析的終末期腎病患者作為研究對象,收集患者年齡、性別、透析齡、腹膜透析前和腹膜透析過程中各階段的相關(guān)資料。選取其中符合納入研究條件的60例維持性腹膜透析患者,將他們隨機分為氯沙坦組、螺內(nèi)酯組、聯(lián)用組及對照組。氯沙坦組予以氯沙坦100mg/d口服,螺內(nèi)酯組予以螺內(nèi)酯20mg/d口服,聯(lián)用組同時予氯沙坦100mg/d及螺內(nèi)酯20mg/d,對照組予除ACEI/ARB及螺內(nèi)酯以外的其他降壓藥物,維持患者血壓目標(biāo)值≤140/90mmHg,觀察時間為6個月。所有患者定期(每3個月)記錄血壓、體重、有無不良反應(yīng)等一般情況；檢測24小時尿量、腹透超濾量,血肌酐、尿素氮,24小時尿肌酐、尿尿素氮、24小時腹透液肌酐、尿素氮,血電解質(zhì)、血白蛋白、前白蛋白、血清總膽固醇、甘油三酯等實驗室指標(biāo)；進行腹膜平衡實驗,評估腹膜轉(zhuǎn)運功能,分析殘余腎功能的變化情況。 結(jié)果： 1.對照組在研究第3個月、第6個月時的RRF值較研究開始時下降,研究開始時為(3.61±0.46) ml/min/1.732,研究第3個月為(3.11±0.68)ml/min/1.732,研究第6個月為(2.57±0.43)ml/min/1.732,差異具有統(tǒng)計學(xué)意義(P=0.0000),其他各組RRF值在三個時間點差異均無顯著性(P0.05)；研究第6個月時對照組RRF值較其他三組低,對照組為(2.57±0.43)ml/min/1.732,氯沙坦組為(3.90±1.11)ml/min/1.732,螺內(nèi)酯組為(3.24±0.66) ml/min/1.732,聯(lián)用組為(3.32±0.66) ml/min/1.732,差異具有統(tǒng)計學(xué)意義(P=0.001),其他時間點四組間差異均無顯著性(P0.05)。 2.對照組在研究第3個月、第6個月時的PET值較研究開始時升高,研究開始時為0.57±0.10,研究第3個月為0.64±0.06,研究第6個月為0.69±0.07,差異具有統(tǒng)計學(xué)意義(P=0.002),其他各組PET值在三個時間點差異均無顯著性(P0.05)；研究第6個月時氯沙坦組、聯(lián)用組較對照組PET值低,氯沙坦組為0.63±0.08,聯(lián)用組為0.62±0.07,對照組為0.69±0.07,差異具有統(tǒng)計學(xué)意義(P=0.036),其他時間點四組間差異均無顯著性(P0.05)。 3.對照組在研究第3個月、第6個月時的24小時尿量較研究開始時下降,研究開始時為(725.00±187.69)ml,研究第3個月為(625.83±150.482)ml,研究第6個月為(405.00±102.74)ml,差異具有統(tǒng)計學(xué)意義(P=0.000),其他各組24小時尿量在三個時間點差異均無顯著性(P0.05)；研究第6個月時對照組24小時尿量較氯沙坦組、螺內(nèi)酯組、聯(lián)用組低,對照組為(405.00±102.74)ml,氯沙坦組為(686.27±263.41)ml,螺內(nèi)酯組為(711.54±302.87)ml,聯(lián)用組為(603.85±233.15)m1,差異具有統(tǒng)計學(xué)意義(P=0.012),其他時間點四組間差異均無顯著性(P0.05)。 4.每組在各個時間點24小時超濾量差異均無統(tǒng)計學(xué)意義(P0.05)；三個時間點各組之間24小時超濾量差異均無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論： 1.隨著透析時間的延長,維持性腹膜透析患者的殘余腎功能、尿量呈逐漸下降趨勢,腹膜溶質(zhì)轉(zhuǎn)運率逐漸升高。 2.血管緊張素受體拮抗劑氯沙坦可延緩腹膜透析患者殘余腎功能下降,保護腹膜功能。 3.醛固酮受體拮抗劑螺內(nèi)酯可延緩殘余腎功能下降,并可能在保護腹膜功能中發(fā)揮一定作用。 4.短期聯(lián)用血管緊張素受體拮抗劑及醛固酮受體拮抗劑對于腹膜透析患者殘余腎功能和腹膜功能保護作用無明顯協(xié)同效應(yīng)。
[Abstract]:Background: Residual renal function and peritoneal function are an important factor in the survival and technical survival of patients with peritoneal dialysis. The renin-angiotensin-aldosterone system is active in the progression of renal disease and changes in the structure and function of the peritoneum, of which angiotensin II and aldosterone are important factors. The protective effects of angiotensin receptor antagonists on the residual renal function and peritoneal function in peritoneal dialysis patients have been studied. However, when the angiotensin receptor antagonist is used for a long time, the level of aldosterone is not stable and sustained, i.e., there is a "aldosterone escape" phenomenon, and it is suggested that the addition of the aldosterone receptor antagonist may play a beneficial protective role. Objective: To observe the effects of losartan and aldosterone antagonist spironolactone on the residual renal function and the peritoneal function of peritoneal dialysis patients. To explore a new method to delay the decrease of the residual renal function in the peritoneal dialysis patients and to protect the peritoneal function, and to improve the pre-treatment of the peritoneal dialysis patients. Methods: Patients with end-stage renal disease undergoing peritoneal dialysis in our hospital from March 2010 to March 2013 were used as the subject of study to collect the phases of the patient's age, sex, dialysis age, pre-peritoneal dialysis and peritoneal dialysis. To select 60 maintenance peritoneal dialysis patients in which the study conditions were met, and they were randomly divided into the losartan group, the spironolactone group, the combination group and the combination group. In the control group, the losartan group was given losartan for 100 mg/ day, and the spironolactone group was administered with spironolactone 20 mg/ d. The combination group was given losartan 100 mg/ d and spironolactone 20 mg/ d, and the control group received other blood pressure-lowering drugs other than ACEI/ ARB and spironolactone, and the blood pressure target value of the patient was maintained at 140/90 mmHg, and the observation time was 6 months. All patients regularly (every 3 months) record the general conditions of blood pressure, body weight, and adverse reaction, etc.; detect the urine volume of 24 hours, the ultrafiltration volume of the abdominal penetration, the blood myocaria, the urea nitrogen, the 24-hour urine myography, the urine urea nitrogen, the 24-hour liquid-permeable myostatin, the urea nitrogen, the blood electrolyte, the blood, The laboratory indexes such as albumin, prealbumin, total serum cholesterol, triglyceride and other laboratory indexes were performed; the peritoneal balance experiment was performed to assess the function of the peritoneal transport and to analyze the change of the residual renal function the situation of chemical engineering Results:1. The RRF value of the control group decreased at the beginning of the study at the third month and the 6th month, and at the beginning of the study (3.61 (0.46) ml/ min/ 1.732, the third month was (3.11-0.68) ml/ min/ 1.732, and the study was (2.57-0.43) ml/ min/ 1.732 for the sixth month (P = There was no significant difference in the RRF of the other groups at three time points (P0.05); the RRF of the control group was lower in the control group at 6 months, the control group was (2.57-0.43) ml/ min/ 1.732, the losartan group (3.90-1.11) ml/ min/ 1.732, the conspironolactone group (3.24-0.66) ml/ min/ 1.732, the combination group (3.32-0.66) ml/ mi N/ 1.732, the difference had statistical significance (P = 0.001), and there was no significant difference between the four groups at other time points. (P0.05).2. In the control group, the PET value at the first 6 months of the study increased at the beginning of the study, 0.57 to 0.10 at the beginning of the study, 0.64 to 0.06 in the third month, 0.69 to 0.07 in the 6-month study, and the difference was of statistical significance. (P = 0.002), there was no significant difference between the other groups of PET (P = 0.002) and the other groups in the three time points (P0.05); in the first 6 months, the content of the losartan group, the combination group and the control group were low, the losartan group was 0.63-0.08, the combined group was 0.62-0.07, the control group was 0.69-0.07, and the difference was of statistical significance. (P = 0.036), no difference between four groups of other time points The urine volume of the control group decreased at the beginning of the study at the third month and the 6th month, and at the beginning of the study (725.00 to 187.69) ml, the third month was (625.83, 150.482) ml, and the study was (405.00 to 102.74) ml for the sixth month and the difference was statistically significant. The significance (P = 0.000) and other groups of 24-hour urine volume had no significant difference in the three time points (P0.05); in the control group at 6 months, the urine volume of the control group was lower than that of the losartan group and the spironolactone group, the combination group was low, the control group was (405.00-102.74) ml, and the losartan group (686.2 7 (263.41) ml, the spironolactone group (711.54-302.87) ml, the combination group (603.85-233.15) ml, the difference had statistical significance (P = 0.012), and the difference between the four groups of other time points There was no significant difference (P0.05).4. There was no significant difference in the amount of ultrafiltration (P0.05). No statistics Conclusion:1. With the prolongation of the dialysis time, the residual renal function and the urine volume of the patients with maintenance peritoneal dialysis are presented. Gradually decreasing, the rate of peritoneal solute transport is increasing gradually.2. Losartan of the angiotensin receptor antagonist can delay the abdomen. 3. Aldosterone receptor antagonist spironolactone can delay the residual renal function. 4. Short-term combination of angiotensin receptor antagonists and aldosterone receptor antagonists for peritoneal dialysis
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5
本文編號：2495261
[Abstract]:Background: Residual renal function and peritoneal function are an important factor in the survival and technical survival of patients with peritoneal dialysis. The renin-angiotensin-aldosterone system is active in the progression of renal disease and changes in the structure and function of the peritoneum, of which angiotensin II and aldosterone are important factors. The protective effects of angiotensin receptor antagonists on the residual renal function and peritoneal function in peritoneal dialysis patients have been studied. However, when the angiotensin receptor antagonist is used for a long time, the level of aldosterone is not stable and sustained, i.e., there is a "aldosterone escape" phenomenon, and it is suggested that the addition of the aldosterone receptor antagonist may play a beneficial protective role. Objective: To observe the effects of losartan and aldosterone antagonist spironolactone on the residual renal function and the peritoneal function of peritoneal dialysis patients. To explore a new method to delay the decrease of the residual renal function in the peritoneal dialysis patients and to protect the peritoneal function, and to improve the pre-treatment of the peritoneal dialysis patients. Methods: Patients with end-stage renal disease undergoing peritoneal dialysis in our hospital from March 2010 to March 2013 were used as the subject of study to collect the phases of the patient's age, sex, dialysis age, pre-peritoneal dialysis and peritoneal dialysis. To select 60 maintenance peritoneal dialysis patients in which the study conditions were met, and they were randomly divided into the losartan group, the spironolactone group, the combination group and the combination group. In the control group, the losartan group was given losartan for 100 mg/ day, and the spironolactone group was administered with spironolactone 20 mg/ d. The combination group was given losartan 100 mg/ d and spironolactone 20 mg/ d, and the control group received other blood pressure-lowering drugs other than ACEI/ ARB and spironolactone, and the blood pressure target value of the patient was maintained at 140/90 mmHg, and the observation time was 6 months. All patients regularly (every 3 months) record the general conditions of blood pressure, body weight, and adverse reaction, etc.; detect the urine volume of 24 hours, the ultrafiltration volume of the abdominal penetration, the blood myocaria, the urea nitrogen, the 24-hour urine myography, the urine urea nitrogen, the 24-hour liquid-permeable myostatin, the urea nitrogen, the blood electrolyte, the blood, The laboratory indexes such as albumin, prealbumin, total serum cholesterol, triglyceride and other laboratory indexes were performed; the peritoneal balance experiment was performed to assess the function of the peritoneal transport and to analyze the change of the residual renal function the situation of chemical engineering Results:1. The RRF value of the control group decreased at the beginning of the study at the third month and the 6th month, and at the beginning of the study (3.61 (0.46) ml/ min/ 1.732, the third month was (3.11-0.68) ml/ min/ 1.732, and the study was (2.57-0.43) ml/ min/ 1.732 for the sixth month (P = There was no significant difference in the RRF of the other groups at three time points (P0.05); the RRF of the control group was lower in the control group at 6 months, the control group was (2.57-0.43) ml/ min/ 1.732, the losartan group (3.90-1.11) ml/ min/ 1.732, the conspironolactone group (3.24-0.66) ml/ min/ 1.732, the combination group (3.32-0.66) ml/ mi N/ 1.732, the difference had statistical significance (P = 0.001), and there was no significant difference between the four groups at other time points. (P0.05).2. In the control group, the PET value at the first 6 months of the study increased at the beginning of the study, 0.57 to 0.10 at the beginning of the study, 0.64 to 0.06 in the third month, 0.69 to 0.07 in the 6-month study, and the difference was of statistical significance. (P = 0.002), there was no significant difference between the other groups of PET (P = 0.002) and the other groups in the three time points (P0.05); in the first 6 months, the content of the losartan group, the combination group and the control group were low, the losartan group was 0.63-0.08, the combined group was 0.62-0.07, the control group was 0.69-0.07, and the difference was of statistical significance. (P = 0.036), no difference between four groups of other time points The urine volume of the control group decreased at the beginning of the study at the third month and the 6th month, and at the beginning of the study (725.00 to 187.69) ml, the third month was (625.83, 150.482) ml, and the study was (405.00 to 102.74) ml for the sixth month and the difference was statistically significant. The significance (P = 0.000) and other groups of 24-hour urine volume had no significant difference in the three time points (P0.05); in the control group at 6 months, the urine volume of the control group was lower than that of the losartan group and the spironolactone group, the combination group was low, the control group was (405.00-102.74) ml, and the losartan group (686.2 7 (263.41) ml, the spironolactone group (711.54-302.87) ml, the combination group (603.85-233.15) ml, the difference had statistical significance (P = 0.012), and the difference between the four groups of other time points There was no significant difference (P0.05).4. There was no significant difference in the amount of ultrafiltration (P0.05). No statistics Conclusion:1. With the prolongation of the dialysis time, the residual renal function and the urine volume of the patients with maintenance peritoneal dialysis are presented. Gradually decreasing, the rate of peritoneal solute transport is increasing gradually.2. Losartan of the angiotensin receptor antagonist can delay the abdomen. 3. Aldosterone receptor antagonist spironolactone can delay the residual renal function. 4. Short-term combination of angiotensin receptor antagonists and aldosterone receptor antagonists for peritoneal dialysis
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5
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