本文選題：厄貝沙坦 + 硝苯地平緩釋片��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:原發(fā)性高血壓是常見的心血管疾病,也是導致人類死亡的常見疾病之一,如腦卒中、冠心病、腎功能衰竭、心力衰竭等。腎臟是調(diào)節(jié)血壓的重要器官,且常是高血壓受累的主要器官之一[1]。其發(fā)生機制目前尚不完全清楚,可能與腎血液動力學改變及血管內(nèi)皮損害有關[2 3]。厄貝沙坦為新型血管緊張素Ⅱ受體拮抗劑(Angiotensin receptor blocker,ARB),具有降低尿蛋白及改善血管內(nèi)皮功能的作用[4]。臨床中對原發(fā)性高血壓合并早期腎損害的患者,降壓藥物的選擇并無統(tǒng)一標準。本實驗通過觀察應用厄貝沙坦、硝苯地平緩釋片治療原發(fā)性高血壓療效,監(jiān)測腎早期損害指標:血清胱抑素C(Cystatin,Cys-C)、尿轉(zhuǎn)鐵蛋白(Urinary transferin,U-TRF),尿微量白蛋白(Urine microalbumin,Um Alb),α1微球蛋白(Alpha1 microglobulin,α1-mG),N乙酰β-氨基葡萄糖苷酶(Urineβ-N-Acetyl glucosaminidase,NAG)水平,隨后進行綜合分析,證實厄貝沙坦、硝苯地平緩釋片治療原發(fā)性高血壓有效,而厄貝沙坦對早期腎損害有保護作用,能延緩慢性腎臟病的進展,提高患者生活質(zhì)量,為臨床治療提供參考依據(jù)。方法:1研究對象:選取2011年9月-2013年9月于衡水市哈勵遜國際和平醫(yī)院門診就診的初次就診未服降壓藥物的患者,入組前均符合我國高血壓防治指南修訂委員會制定的《中國高血壓防治指南》(2010年修訂版第三版),均為2級高血壓,臨床無癥狀,尿微量白蛋白/肌酐比值介于30-300mg/g,血胱抑素(Cys-c)升高,二者并存或其中一項大于正常值。腎功能、血肌酐正常,同時需排除繼發(fā)性高血壓、原發(fā)性腎臟疾病、痛風、心臟瓣膜病、心肌病、糖尿病、感染、血液病、肝功能異常和自身免疫性疾病等。本課題共收集56例患者,隨機對照分為厄貝沙坦組、硝苯地平緩釋片組,厄貝沙坦組男15例,女14例,平均年齡(58±10.4)歲;硝苯地平緩釋片組男13例,女14例,平均年齡(59±9.2)歲。兩組在性別、年齡、體重方面差異無顯著性(P0.05),具有可比性。2方法:厄貝沙坦組起始口服量為150mg/d,硝苯地平緩釋片組起始口服量為10mg/d,若1周后血壓≥140/90mm Hg,逐漸增加藥物劑量,厄貝沙坦組最大劑量300mg/d;硝苯地平緩釋片組最大劑量40mg/d。連續(xù)口服10周,目標血壓定為安靜坐位血壓140/90mm Hg,每周測量血壓至少4次。2周后血壓不能控制至目標水平者加用美托洛爾25-50mg/d,若血壓仍不能控制退出本實驗,厄貝沙坦組退出2例,硝苯地平緩釋片組退出1例。厄貝沙坦組失訪1例,硝苯地平緩釋片組失訪1例。血壓控制在140/90mm Hg以后維持當前劑量,并觀察藥物不良反應。3觀察指標:所選對象采用每周測量血壓至少4次,并分別在治療前及治療后第2、4、8、10周清晨空腹(禁食8-12小時)抽取靜脈血3ml在Cobas 8000上檢測Cys-c;同時段收集新鮮中段晨尿在SIEMENS BNⅡ上檢測U-TRF、Um Alb、U-α1-mG、NAG的水平。根據(jù)化驗結果比較厄貝沙坦組及硝苯地平緩釋片組治療效果的差異。4統(tǒng)計學方法:采用SPSS 19.0統(tǒng)計軟件對所得數(shù)據(jù)進行分析,計量資料用均數(shù)±標準差((?)±s)表示,行配對t檢驗,計數(shù)資料以率表示,采用x2檢驗,以P0.05為差異無統(tǒng)計學意義,P0.05為差異具有統(tǒng)計學意義。結果:1兩組患者在年齡、性別、體重、用藥前Cys-c、U-TRF、Um Alb、U-α1-mG、NAG水平上均無明顯差異(P0.05)。2厄貝沙坦組降低2級原發(fā)性高血壓患者收縮壓及舒張壓有統(tǒng)計學差異(P0.05)。3硝苯地平緩釋片組降低2級原發(fā)性高血壓患者收縮壓及舒張壓有統(tǒng)計學差異(P0.05)。4治療前厄貝沙坦組、硝苯地平緩釋片組收縮壓、舒張壓數(shù)值比較無統(tǒng)計學意義(P0.05);治療后兩組收縮壓、舒張壓數(shù)值比較無統(tǒng)計學意義(P0.05)。5硝苯地平緩釋片組治療后Cys-c、U-TRF、Um Alb、U-α1-mG、NAG降低,較治療前有統(tǒng)計學差異(P0.05)。6厄貝沙坦組治療后Cys-c、U-TRF、Um Alb、U-α1-mG、NAG降低,較治療前有統(tǒng)計學差異(P0.05)。7厄貝沙坦組較硝苯地平緩釋片組治療后降Cys-c、U-TRF、Um Alb、U-α1-mG、NAG有統(tǒng)計學差異(P0.05)。結論:本研究數(shù)據(jù)顯示:厄貝沙坦組、硝苯地平緩釋片組治療2級原發(fā)性高血壓均有效;厄貝沙坦組、硝苯地平緩釋片組治療后Cys-c、U-TRF、Um Alb、U-α1-mG、NAG水平降低。兩組比較厄貝沙坦能更有效地降低腎早期損傷指標。
[Abstract]:Objective: essential hypertension is a common cardiovascular disease, which is one of the common diseases that cause human death, such as stroke, coronary heart disease, renal failure and heart failure. The kidney is an important organ for regulating blood pressure and is often one of the main organs involved in hypertension, [1]. is not completely clear and may be associated with renal blood. Dynamic changes and vascular endothelial damage related to [2 3]. erbesartan is a new angiotensin II receptor antagonist (Angiotensin receptor blocker, ARB), which has the effect of reducing urine protein and improving vascular endothelial function in [4]. clinical patients with primary hypertension and early renal damage, the selection of antihypertensive drugs has no unified standard. The effect of irbesartan and Extended Release Nifedipine Tablets in the treatment of primary hypertension was observed in this experiment. The indexes of early renal damage were monitored: serum cystatin C (Cystatin, Cys-C), urinary transferrin (Urinary transferin, U-TRF), urinary microalbumin (Urine microalbumin, Um Alb), alpha 1 microglobulin (Alpha1 microglobulin, alpha), acetacetyl beta ammonia The level of Urine beta -N-Acetyl Glucosaminidase (NAG) and subsequent comprehensive analysis confirmed that erbesartan is effective in the treatment of essential hypertension, while irbesartan has protective effects on early renal damage. It can delay the progression of chronic kidney disease, improve the quality of life, and provide reference for clinical treatment. Methods: 1 research subjects: selected patients who did not take antihypertensive drugs in the outpatient department of Hengshui Halison International Peace Hospital in September 2011 -2013, were all in line with the China guidelines for hypertension prevention and control (third edition of 2010 Revision), which were all in grade 2 hypertension. The bed was asymptomatic, the ratio of urine microalbuminuria / creatinine was between 30-300mg/g and serum cystatin (Cys-c). The coexistence of two or one of them was greater than normal. Renal function, blood creatinine was normal, and secondary hypertension, primary kidney disease, gout, heart valvular disease, cardiomyopathy, diabetes, infection, blood disease, liver dysfunction, and self immunity 56 patients were randomly divided into erbesartan group, Extended Release Nifedipine Tablets group, erbesartan Group 15, female 14, average age (58 + 10.4) years, 13 men in Extended Release Nifedipine Tablets group and 14 female, average age (59 + 9.2) years. There was no significant difference in sex, age and weight (P0.05) in the two group (two group). Comparable.2 method: the initial oral dose of erbesartan group was 150mg/d and the initial oral dose of Extended Release Nifedipine Tablets group was 10mg/d. If the blood pressure was more than 140/90mm Hg 1 weeks later, the drug dosage was gradually increased, the maximum dose of irbesartan group was 300mg/d, the maximum dose of 40mg/d. in Extended Release Nifedipine Tablets group was 10 weeks, and the target blood pressure was set as the quiet sitting position of the blood pressure 140. /90mm Hg, when the blood pressure was measured at least 4 times a week for at least 4 weeks, the blood pressure was not controlled at the target level plus metoprolol 25-50mg/d. If the blood pressure was still not controlled to exit the experiment, the erbesartan group withdrew from 2 cases, the Extended Release Nifedipine Tablets group withdrew from 1 cases, the Irbesartan group lost 1 cases, and the Extended Release Nifedipine Tablets group lost 1 cases. The blood pressure control was in 140/90mm Hg. To maintain the current dose, and to observe the.3 observation index of adverse drug reactions: the selected subjects were measured at least 4 times a week, and the venous blood 3ml was detected on Cobas 8000 before and after 2,4,8,10 week (fasting) in the morning before and after the treatment (8-12 hours), and at the same time, the fresh middle morning urine was collected to detect U-TR on SIEMENS BN II. F, Um Alb, U- alpha 1-mG, NAG level. According to the test results, compare the difference between the ebesartan group and the Extended Release Nifedipine Tablets group,.4 statistics method: the data were analyzed by the SPSS 19 statistical software, the measurement data were shown with the mean + standard deviation ((?) + s), the paired t test, the count data were expressed, the x2 test was adopted, and P was used for P. 0.05 the difference was not statistically significant, P0.05 was statistically significant. Results: 1 two groups of patients in age, sex, weight, before Cys-c, U-TRF, Um Alb, U- alpha 1-mG, NAG level were not significantly different (P0.05).2 in the erbesartan group decreased the systolic pressure and diastolic pressure of grade 2 primary hypertension (P0.05).3 nifedipine There was significant difference in systolic pressure and diastolic pressure in patients with 2 grade primary hypertension (P0.05). There was no significant difference in systolic pressure and diastolic pressure in Extended Release Nifedipine Tablets group before.4 treatment (P0.05). There was no significant difference in systolic pressure and diastolic pressure in the two groups after treatment (P0.05).5 Extended Release Nifedipine Tablets group After treatment, Cys-c, U-TRF, Um Alb, U- alpha 1-mG, NAG decreased, and there were statistical differences compared with those before treatment (P0.05). Conclusion: the data of this study showed that the erbesartan group and Extended Release Nifedipine Tablets group were effective in the treatment of grade 2 primary hypertension; the erbesartan group and the Extended Release Nifedipine Tablets group were treated with Cys-c, U-TRF, Um Alb, U- alpha 1-mG, and NAG level decreased. The two groups were more effective in reducing the index of early renal injury.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1;R692

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