美托洛尔对隐匿性肾功能不全的高血压患者肾小球滤过功能的影响  

Effect of metoprolol on glomerular filtration function in hypertensive patients with concealed renal insufficiency

作　　者：骆雷鸣[1] 朱启伟[1] 史军[1] 杨雪[1] 宋康兴 朱兵[1] 刘国树[1] 叶平[1] 

机构地区：[1]解放军总医院南楼心血管二科,北京100853

出　　处：《药物不良反应杂志》2006年第3期174-177,共4页Adverse Drug Reactions Journal

摘　　要：目的:评价β受体阻滞剂美托洛尔单独或与血管紧张素转换酶(ACE)抑制剂贝那普利联合应用对隐匿性肾功能不全的轻、中度高血压患者肾小球滤过功能的影响。方法:73例隐匿性肾功能不全的高血压患者,随机分为美托洛尔(MET)、美托洛尔+贝那普利(MET+BEN)两组,分别应用美托洛尔50～75mg/d或美托洛尔25mg/d+贝那普利5～10mg/d,疗程6个月。血压控制目标为140/90mmHg。治疗前和治疗满6个月时,检测两组患者血尿酸(SUA)血肌酐(Scr)和肾小球滤过率GFR。结果:①治疗后,MET组与MET+BEN组的血压平均水平的差别均无统计学意义(131.3±9.9/71.9±10.5,132.0±10.2/68.9±10.7mmHg,P均>0.05),血压控制达标率亦无显著差别(78.4%,77.8%,P>0.05)。②治疗后MET组血尿酸、肌酐较治疗前升高(439±62,429±57mmol/L,P<0.05;109±17,103±14μmol/L,P<0.01),肾小球滤过率轻度下降(49.9±6.9,52.9±5.8mL/min·1.73m2,P<0.01);③MET+BEN组血尿酸、血肌酐较治疗前降低(417±57,426±62mmol/L,P<0.01;98±12,105±13μmol/L,P<0.01),肾小球滤过率较治疗前升高(54.7±6.2,51.3±5.6mL/min·1.73m2,P<0.01)。④治疗6个月后,MET+BEN组血尿酸、血肌酐均低于MET组(417±57,439±62mmol/L,P<0.01;98±12,109±17μmol/L,P<0.01),肾小球滤过率高于MET组(54.7±6.2,49.9±6.9ml/min·1.73m2,P<0.01)。结论:对合并隐匿性肾功能不全的高血压患者,应避免单独应用美托洛尔,以免加重肾小球滤过功能的损害;而美托洛尔与贝那普利联合应用,可能有益于肾功能的保护。Objective： To estimate the effect of beta-blocker metoprolol or combination of metoprolol and ACE inhibitor benazapril on glomerular filtration function in mild or moderate hypertensive patients with concealed renal insufficiency （CRI）. Methods： Seventy-three hypertensive patients with CRI were divided randomly into two groups, metoprolol （MET） group and metoprolol ＋ benazapril （MET＋BEN） group, Patients in the two groups received 6 months therapy with metoprolol 50-75 mg daily or metoprolol 25 mg＋ benazapril 5-10 nag daily respectively. The target of blood pressure was under 140/90 mm Hg, The serum uric acid （SUA）, serum creatinine （SCr） and glomerular filtration rate （GFR） were investigated before therapy and after 6 months of therapy. Results： ①The systolic and diastolic blood pressure level, and control rate were not different between the two groups （131.3 ±9.9 vs 71.9±10.5, 132.0±10.2 vs 68. 9±10.7 mm Hg, 78.4% vs 77.8%, P〉0.05）; ②In MET group, SUA and SCr increased and GFR decreased after 6 months of therapy than those before （from 429±57 to 439±62 mmol/L P〈0.05, from 103±14 to 109±17 μmol/L P〈0. 01, from 52.9±5.84 to 49.9± 6.9ml/min·1.73 m^2 P〈0.01 respectively）;③in MET＋BEN group, compared with before therapy, SUA and SCr decreased and GFR increased significantly alter therapy （from 426±62 to 417±57 mmol/L, P〈0.01;from 105±13 to 98± 12 μmol/L, P〈0.01, from51.3 ±5.6 to 54.7±6.2 mL/min·1.73 m^2, P〈0.01 respectivly）： ④After 6 months of therapy, SUA and SCr in MET＋BEN group were lower than those in MET group （417±57 vs 439±62 mmol/L, P〈0.01; 98±12 vs 109±17 μmol/L, P〈0.01）, GFR higher than that in MET group （54.7± 6.2 vs 49.9± 6.9 ml/min·1.73m^2, P〈0.01）. Conclusion： Metoprolol monotherapy might not be used for treating hypertensive patients with concealed renal insufficiency for its decreasing glomerular filtration functing. But thecombined therapy with metoprolol and ACE inhibitor benazapril

关 键 词：高血压 隐匿性肾功能不全 美托洛尔 肾小球滤过功能 

分 类 号：R692.5[医药卫生—泌尿科学] R544.1[医药卫生—外科学]