本文選題：腎動(dòng)脈狹窄 + 動(dòng)脈粥樣硬化��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:本研究主要應(yīng)用小劑量瑞舒伐他汀聯(lián)合中藥血脂康治療腎動(dòng)脈粥樣硬化性高血壓,進(jìn)而評(píng)價(jià)其療效及安全性。方法:2015.6-2016.6期間入選吉林大學(xué)第二醫(yī)院住院高血壓患者90例(腎動(dòng)脈無狹窄組15例+腎動(dòng)脈狹窄組75例),其中腎動(dòng)脈狹窄經(jīng)腎動(dòng)脈彩超及腎動(dòng)脈CTA診斷,在治療過程中腎動(dòng)脈狹窄患者中有3名患者中途退出(1名在治療過程中出現(xiàn)單側(cè)腎動(dòng)脈完全閉塞,余2名行腎動(dòng)脈PCI治療)。將余72例腎動(dòng)脈狹窄患者根據(jù)給予不同的治療方案分為對(duì)照組N組(僅給予降壓藥物n=18)、西藥治療組A組(降壓藥物+瑞舒伐他汀10mg n=18)、中藥治療組B組(降壓藥物+血脂康1200mg n=18)、小劑量中西藥聯(lián)合治療組C組(降壓藥物+瑞舒伐他汀5mg+血脂康1200mg n=18)。評(píng)價(jià)如下內(nèi)容:1)探討腎動(dòng)脈粥樣硬化性高血壓的發(fā)病機(jī)制,為臨床降脂藥物應(yīng)用于此類高血壓的治療提供理論依據(jù)。2)測(cè)定血脂及動(dòng)脈粥樣硬化炎癥因子(同型半胱氨酸(Hcy)、髓過氧化物酶(MPO)、內(nèi)皮素-1(ET-1)一氧化氮(NO)及腎素)水平,觀察其與腎動(dòng)脈狹窄程度是否存在相關(guān)性。3)N、A、B、C四組患者治療1個(gè)月、6個(gè)月及12個(gè)月后,觀察其血脂、收縮壓(SBP)、舒張壓(DBP)、腎功能(Cr、GFR)、轉(zhuǎn)氨酶(AST、ALT)及肌酸激酶(CK)水平的變化;12個(gè)月時(shí)復(fù)查MPO、Hcy、NO、ET-1情況,并通過腎動(dòng)脈彩超或腎動(dòng)脈CTA評(píng)價(jià)腎動(dòng)脈狹窄程度的改善情況。4)評(píng)價(jià)各治療方案的安全性,為腎動(dòng)脈粥樣硬化性高血壓患者提供最佳的治療方案。結(jié)果：1)高血壓伴腎動(dòng)脈狹窄組中對(duì)照組(N組)、西藥治療組(A組)、中藥治療組(B組)、小劑量中西藥聯(lián)合治療組(C組)四組年齡、性別、體重、BMI、吸煙史、糖尿病、腦卒中、冠心病病史以及服用血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)與鈣離子拮抗劑(CCB)降壓藥物人數(shù)比例無統(tǒng)計(jì)學(xué)差異(P0.05),而腎動(dòng)脈狹窄各組高血壓患者的吸煙人數(shù)、合并糖尿病、腦卒中及冠心病比例明顯高于腎動(dòng)脈無狹窄組,且差異具有統(tǒng)計(jì)學(xué)意(P0.05);2)高血壓伴腎動(dòng)脈狹窄組SBP明顯高于腎動(dòng)脈無狹窄組(P0.05),但兩組DBP差距較小,差異無明顯統(tǒng)計(jì)學(xué)意義(P0.05);3)高血壓伴腎動(dòng)脈狹窄組(N、A、B、C四組)SBP及DBP情況治療1年后均較治療前明顯降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。在治療6個(gè)月及12個(gè)月時(shí)給予降脂治療的A、B、C三組較N組SBP降低更為明顯,具有統(tǒng)計(jì)學(xué)意義(P0.01);經(jīng)治療6個(gè)月時(shí)A、B、C三組較N組DBP明顯降低,具有統(tǒng)計(jì)學(xué)意義(P0.01);12個(gè)月時(shí)A、C兩組DBP降低較N、B兩組更為明顯,具有統(tǒng)計(jì)學(xué)意義(P0.01);而A組與C組、N組與B組之間DBP降低無統(tǒng)計(jì)學(xué)意義(P0.05);4)高血壓伴腎動(dòng)脈狹窄組72例患者治療前TC、LDL-C水平高于腎動(dòng)脈無狹窄組(P0.05);在治療12個(gè)月時(shí)A、B、C三組TC、TG、LDL-C水平明顯低于治療前,HDL-C水平高于治療前,比較具有統(tǒng)計(jì)學(xué)意義(P0.05)。治療6個(gè)月及12個(gè)月時(shí)A、C兩組TC減低幅度明顯優(yōu)于B組,比較具有統(tǒng)計(jì)學(xué)意義(P0.05);治療12個(gè)月時(shí)A、C兩組TG減低幅度明顯優(yōu)于B組,比較具有統(tǒng)計(jì)學(xué)意義(P0.05);治療6個(gè)月及12個(gè)月時(shí)C組LDL-C減低幅度優(yōu)于A、B兩組,比較具有統(tǒng)計(jì)學(xué)意義(P0.05);而給予降脂治療的三組HDL-C治療前后差異無統(tǒng)計(jì)學(xué)意義(P0.05);5)高血壓伴腎動(dòng)脈狹窄組(N、A、B、C四組)治療1年后腎動(dòng)脈收縮期最大血流速度(PSV)水平明顯低于治療前(P0.05)。A、B、C三組較N組降低更為明顯(P0.05)。且A、C兩組改善情況優(yōu)于B組(P0.05);A、C兩組間無明顯差異(P0.05)。6)72例高血壓伴腎動(dòng)脈狹窄患者中有28例經(jīng)腎動(dòng)脈CTA確診,根據(jù)腎動(dòng)脈管腔狹窄程度其分為輕度(50%)、中度(50%-75%)和重度(76-99%)。經(jīng)治療1年后A、B、C三組中,重度狹窄人數(shù)無明顯變化,而中度狹窄人數(shù)較之前有所減低(P0.05),且A組略優(yōu)于B、C組,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。7)高血壓伴腎動(dòng)脈狹窄組72例患者中NO、ET-1、MPO、腎素以及Hcy水平明顯高于腎動(dòng)脈無狹窄組(P0.05),經(jīng)治療1年后給予降脂治療的A、B、C三組NO、ET-1、MPO及Hcy水平水平較前明顯減低(P0.05),除MPO指標(biāo)外,余指標(biāo)C組均較A、B兩組降低幅度明顯(P0.05)。A、C兩組MPO值較B組降低明顯(P0.05);8)高血壓伴腎動(dòng)脈狹窄組72例患者治療前MPO水平與LDL-C水平呈正相關(guān)(R=0.290,P=0.014)。該72例患者治療前PSV水平與SBP和DBP水平呈正相關(guān)(R=0.873,P0.01);9)高血壓伴腎動(dòng)脈狹窄組(N、A、B、C四組)治療前GFR中度降低(30~60ml/min)人數(shù)所占比例差異無統(tǒng)計(jì)學(xué)意義(P0.05);經(jīng)治療1年后A、B、C三組GFR中度人數(shù)所占比例低于治療前(P0.05);而A、C兩組較B組比例更低(P0.05);A、C兩組間無明顯差異(P0.05)。10)高血壓伴腎動(dòng)脈狹窄組(N、A、B、C四組)各組治療前后ALT、AST及水平無明顯差異(P0.05)。11)72例高血壓伴腎動(dòng)脈狹窄組(N、A、B、C四組)各組治療前后雖CK水平變化具有統(tǒng)計(jì)學(xué)意義(P0.05)。但與治療前相比各組CK值未見明顯升高,且無患者出現(xiàn)肌痛現(xiàn)象。12)在給予降脂藥物三組(A、B、C三組)中僅3例患者出現(xiàn)一過性胃腸道反應(yīng)。結(jié)論:1)、總膽固醇(TC)、低密度脂蛋白(LDL-C)、腎素、髓過氧化物酶(MPO)、同型半胱氨酸(Hcy)、一氧化氮(NO)以及內(nèi)皮素-1(ET-1)共同參與腎動(dòng)脈粥樣硬化性高血壓的形成;2)、腎動(dòng)脈粥樣硬化患者腎動(dòng)脈狹窄程度與收縮壓(SBP)和舒張壓(DBP)水平呈正相關(guān);3)、在給予降脂、抗炎、抗氧化應(yīng)激治療后,腎動(dòng)脈粥樣硬化患者的血壓、TC、LDL-C、MPO、Hcy、NO、ET-1水平較治療前明顯減低,以小劑量瑞舒伐他汀聯(lián)合血脂康效果最為顯著;4)、小劑量瑞舒伐他汀聯(lián)合血脂康在治療腎動(dòng)脈粥樣硬化性高血壓具有較好的安全性。
[Abstract]:Objective: This study mainly used small dose rosuvastatin and xuexuekang in the treatment of renal atherosclerotic hypertension, and then evaluated its efficacy and safety. Methods: during the period of 2015.6-2016.6, 90 cases of hypertensive patients were admitted to second hospitals of Jilin University (15 cases of renal artery stenosis group + renal artery stenosis group 75 cases), including renal artery. By renal artery color Doppler ultrasound and renal artery CTA diagnosis, 3 patients were withdrawn from the renal artery stenosis during the treatment process (1 in the treatment process, the unilateral renal artery was completely obliterate, and the remaining 2 were treated with renal artery PCI). The remaining 72 patients with renal artery stenosis were divided into the control group N group according to the different treatment schemes. Pressure drug n=18), western medicine treatment group A group (antihypertensive drugs + rosuvastatin 10mg n=18), Chinese medicine treatment group B group (antihypertensive drugs + Xuezhikang 1200mg n=18), small dose of Chinese and Western medicine group C group (antihypertensive drugs + rosuvastatin 5mg+ Xuekang 1200mg n=18). Evaluation of the following contents: 1) to explore the pathogenesis of renal atherosclerotic hypertension. To provide a theoretical basis for the use of clinical lipid lowering drugs in the treatment of such hypertension (.2) to determine the levels of blood lipids and atherosclerotic inflammatory factors (homocysteine (Hcy), myeloperoxidase (MPO), endothelin -1 (ET-1) nitric oxide (NO) and renin), and whether there is a correlation with the degree of renal artery stenosis in.3) N, A, B, C four. After 1 months, 6 months and 12 months, the changes of blood lipid, systolic pressure (SBP), diastolic pressure (DBP), renal function (Cr, GFR), transaminase (AST, ALT) and creatine kinase (CK) were observed, and MPO, Hcy, NO, and ET-1 were reviewed at 12 months, and the treatment regimens were evaluated by renal artery color Doppler ultrasound or renal artery CTA evaluation of renal artery stenosis. Safety, to provide the best treatment for patients with renal atherosclerotic hypertension. Results: 1) hypertension with renal artery stenosis group (group N), western medicine treatment group (group A), Chinese medicine treatment group (group B), small dose of Chinese and Western medicine group (group C) group (group C) of age, sex, weight, BMI, smoking history, diabetes, stroke, coronary heart disease history There was no significant difference in the proportion of antihypertensive drugs with angiotensin converting enzyme inhibitor (ACEI) and calcium ion antagonist (CCB), while the number of smokers in hypertensive patients with renal artery stenosis, diabetes, cerebral apoplexy and coronary heart disease were significantly higher than those in the renal artery without stenosis, and the difference was statistically significant (P0.05); 2) The SBP in the blood pressure and renal artery stenosis group was significantly higher than that of the renal artery stenosis group (P0.05), but the difference between the two groups was smaller and the difference was not significant (P0.05); 3) the cases of hypertension and renal artery stenosis group (N, A, B, C four) were significantly lower than before the treatment (P0.05) after 1 years, and the difference was statistically significant (P0.05). In the treatment of 6 months and 12 months. A, B, C three in the three groups were significantly lower than those in the N group, with statistical significance (P0.01), while the A, B, C three groups were significantly lower than those in the N group after 6 months of treatment, with statistical significance (P0.01); 12 months, two groups were lower than those in the two groups. There was no statistical significance (P0.05); 4) in 72 patients with hypertension and renal artery stenosis, the level of LDL-C was higher than that of the renal artery without stenosis group (P0.05), and the level of TC, TG, LDL-C in group A, B, C three was significantly lower than that before treatment for 12 months, and the HDL-C level was higher than that before the treatment, which was significantly higher than that before the treatment (P0.05). Two groups were treated for 6 months and 12 months. The reduction was significantly better than that in the B group (P0.05). The TG reduction amplitude in A and C two groups was significantly better than that in group B (P0.05) at 12 months of treatment, and the decreasing amplitude of LDL-C in group C was superior to A and B two at 6 months and 12 months, and the three groups were given lipid lowering treatment before treatment. There was no statistical significance (P0.05); 5) the maximum blood flow velocity (PSV) of renal artery systolic blood flow rate (PSV) was significantly lower than that before treatment (P0.05).A, B and C three were significantly lower than that of N group (P0.05) in the group of hypertension and renal artery stenosis group (group N, A, B, C four) after 1 years of treatment (P0.05). Moreover, the two groups were better than those in the group of 72. 72 cases had no significant difference between the two groups. 28 cases of hypertensive patients with renal artery stenosis were diagnosed by renal artery CTA. According to the degree of renal artery stenosis, they were divided into mild (50%), moderate (50%-75%) and severe (76-99%). After 1 years of treatment, there was no significant change in the number of severe stenosis in group A, B and C, but the number of moderate narrow narrowing was lower than before (P0.05), and A group was slightly better than B, C group, but poor but poor. No statistical significance (P0.05).7) the levels of NO, ET-1, MPO, renin and Hcy in 72 patients with hypertension and renal artery stenosis were significantly higher than those in the renal artery without stenosis group (P0.05). After 1 years of treatment, the levels of A, B, C three were significantly lower than those in the previous group. Except for the index, the remaining indexes were all lower than those in the two groups. The low amplitude (P0.05).A, C two group MPO values were lower than those in the B group (P0.05); 8) there was a positive correlation between MPO level and LDL-C level in 72 patients with renal artery stenosis before treatment (R=0.290, P=0.014). The PSV level in the 72 patients before treatment was positively correlated with the level of SBP, 9) treatment of renal artery stenosis group (four groups). There was no significant difference in the proportion of GFR moderate decrease (30~60ml/min) before treatment (P0.05). After 1 years of treatment, the proportion of moderate number of GFR in group A, B, C three was lower than that before treatment (P0.05); and A, C two was lower than B group (P0.05). There was no significant difference in post ALT, AST and level (P0.05).11) 72 cases of hypertension with renal artery stenosis group (N, A, B, C four), the changes of CK levels were statistically significant before and after treatment (P0.05). But there was no significant increase in CK values compared with those before treatment, and no patients appeared muscle pain.12) in the three groups (three groups). Conclusion: 1) total cholesterol (TC), low density lipoprotein (LDL-C), renin, myeloperoxidase (MPO), homocysteine (Hcy), nitric oxide (NO) and endothelin -1 (ET-1) are involved in the formation of renal atherosclerotic hypertension; 2) the degree of renal artery stenosis and systolic blood pressure in patients with renal atherosclerosis. (SBP) and diastolic pressure (DBP) level positive correlation; 3) after the treatment of lipid lowering, anti-inflammatory, and antioxidant stress, the blood pressure, TC, LDL-C, MPO, Hcy, NO, ET-1 in patients with renal atherosclerosis were significantly lower than before the treatment, and the effect of small dose of rosuvastatin combined with Xuezhikang was the most significant; 4) small dose of rosuvastatin combined with Xuezhikang in the treatment of kidney Atherosclerotic hypertension has better safety.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1;R692

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6 陶貴周;唐偉敬;;瑞舒伐他汀對(duì)心肌梗死后細(xì)胞凋亡及心室重構(gòu)的影響[A];中華醫(yī)學(xué)會(huì)第11次心血管病學(xué)術(shù)會(huì)議論文摘要集[C];2009年

7 孫勇;郭航遠(yuǎn);劉龍斌;史亞非;孫愛靜;許富康;池菊芳;;瑞舒伐他汀抑制低密度脂蛋白受體基因缺陷小鼠基質(zhì)金屬蛋白酶-2表達(dá)和粥樣斑塊形成[A];中華醫(yī)學(xué)會(huì)第11次心血管病學(xué)術(shù)會(huì)議論文摘要集[C];2009年

8 畢京峰;李文淑;陳紅鴿;胡琳;劉軍;孫斌;屠舒;魏振滿;;瑞舒伐他汀鈣膠囊人體生物等效性研究[A];中國(guó)成人醫(yī)藥教育論壇（4）[C];2011年

9 杜瑞雪;葉平;;瑞舒伐他汀治療對(duì)周圍動(dòng)脈粥樣硬化患者粘附、趨化因子的影響[A];第十三次全國(guó)心血管病學(xué)術(shù)會(huì)議論文集[C];2011年

10 胡昕嬰;葛均波;孫愛軍;謝新星;;瑞舒伐他汀促大鼠急性心肌梗死后心肌組織修復(fù)的研究[A];第十三次全國(guó)心血管病學(xué)術(shù)會(huì)議論文集[C];2011年

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