厄贝沙坦和依那普利对原发性高血压患者肾功能的影响  

The effects of irbesartan and enalapril on the renal function in patients with essential hypertension

作　　者：吴奇志[1] 张敏[1] 翁朝航[1] 范可军[1] 陈志松[1] 陈孝良[1] 

机构地区：[1]厦门大学附属中山医院湖里分院内科,361006

出　　处：《疑难病杂志》2010年第1期9-11,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨血管紧张素Ⅱ受体拮抗剂(ARB)和血管紧张素转换酶抑制剂(ACEI)对原发性高血压(EH)患者肾功能的影响。方法采用随机、单盲和平行对照方法,经2周冲洗期后,60例EH患者随机分为2组进行16周治疗,每日1次口服厄贝沙坦150 mg(n=30)或依那普利5 mg(n=30),4周后如舒张压(DBP)≥90 mm Hg则剂量加倍。治疗后测量血压、心率(HR)并记录症状、体征。治疗前后分别测定血清肌酐(Cr)、尿素氮(BUN)、内生肌酐清除率(Ccr)和24 h尿蛋白(UTP)、尿白蛋白(Alb),血、尿α_1及β_2微球蛋白(α_1-MG和β_2-MG)的排泄率。20例健康体检者作为健康对照组。结果(1)2组血压均明显降低(P<0.05)。(2)治疗前EH组患者Ccr显著低于健康对照组(P<0.01),血、尿α_1-MG和β_2-MG及UTP、Alb显著高于健康对照组(P<0.05或P<0.01)。(3)治疗16周后,2组UTP、Alb,血、尿α_1-MG和β_2-MG均显著下降(P<0.05或P<0.01),其中病程≥10年者较病程<10年者下降幅度较大(P<0.05)。(4)咳嗽发生率厄贝沙坦组(6.7%)明显低于依那普利组(26.7%)(P<0.01)。结论(1)EH患者早期即有肾功能损害。(2)厄贝沙坦可减轻和延缓高血压引起的肾功能损害,且病程较长者获益较大,其效果可能与依那普利相似。Objective To evaluate the effects of angiotensin II receptor antagonist （ARB） and angiotensin converting enzyme inhibitor （ACEI） on the renal function in essential hypertension （EH） patients. Methods A randomized, single blind and parallel study was performed in our study. After 2 weeks washout run in period,60 patients were divided into 2 groups randomly,and underwent 16 week continuously therapy,which either 150 mg irbesartan （ n = 30） or 5 mg enalapril （ n = 30） once per day. Dose doubling was required if diastolic blood pressure （DBP） ≥90 mm Hg （1 mm Hg = 0. 133 kPa） after 4 weeks. The blood pressure, heart rate （HR）, symptoms and signs were recorded. The serum creatiuine （Cr）, blood urea nitrogen （BUN）, endogenous creatinine clearance rate （Ccr） ,24h urine protein excretion total urine protein （UTP）, albumin （Alb）, serum and urine α1-microglobulin and β2-microglobulin（α1-MG and β2-MG） excretion, urine sodium and potassium were compared before and after treatment. Another 20 healthy subjects were enrolled as normal control group. Results （ 1 ） The irbesartan and enalapril reduced the blood pressure significantly in essential hypertension after 16 week continuously treatment（ P 〈 0.05）. （2） Before treatment,the Ccr was significantly lower in EH group than that in control group （ P 〈 0.01 ） ,while the UTP,Alb,serum and urine α1-MG and β2- MG were significantly higher in EH group than those in control group （P 〈 0.05 or P 〈 0.01 ）. （3）Both irbesartan and enalapril treatment group decreased UTP and Alb,serum and urine α1-MG and β2-MG after 16 week treatment（ P 〈 0.05 or P 〈 0.01 ）. For those whose hypertension course were more than 10 years,the changes were more significant （ P 〈 0.05 ）. （4）The prevalence of cough in irbesartan treatment group was significantly lower than that in enalapril treatment group （ 6.7% vs 26.7% , P 〈 0.01 ）. Conclusion （ 1 ） In the early stage of hypertension, re

关 键 词：厄贝沙坦 依那普利 高血压 原发性 肾功能 

分 类 号：R544.1[医药卫生—心血管疾病] R692[医药卫生—内科学]