苯磺酸左旋氨氯地平和坎地沙坦酯治疗原发性高血压伴蛋白尿患者的临床研究  

Clinical trial of levoamlodipine besylate and candesartan cilexetil in the treatment of primary hypertension patients with proteinuria

作　　者：苟连平[1] 刘世平[1] 胡龙江[1] 

机构地区：[1]川北医学院附属医院心内科,四川南充637000

出　　处：《中国临床药理学杂志》2016年第18期1646-1649,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的观察苯磺酸左旋氨氯地平与坎地沙坦酯对原发性高血压伴蛋白尿患者的肾保护作用。方法根据24 h尿蛋白总量(Pro)和使用药物的不同,将208例原发性高血压伴蛋白尿患者分为4组:A组(1 g/24 h≤Pro<3.5 g/24 h)服用苯磺酸左旋氨氯地平2.5 mg·d^(-1),B组(1 g/24 h≤Pro<3.5 g/24 h)服用坎地沙坦酯4 mg·d^(-1),C组(Pro<1 g/24 h)服用苯磺酸左旋氨氯地平2.5mg·d^(-1),D组(Pro<1 g/24 h)服用坎地沙坦酯4 mg·d^(-1)。各组均观察48周,比较治疗后肾小球滤过率(GFR)、尿蛋白及血压的情况。结果治疗28周后,A组的肾小球滤过率为(59.42±38.11)m L/1.73 m2·min,B组为(60.13±9.72)m L/1.73 m2·min,C组为(58.32±10.21)m L/1.73 m2·min,D组为(58.73±9.41)m L/1.73 m2·min,治疗48周后,A组肾小球滤过率为(66.30±81.92)m L/1.73 m2·min,B组肾小球滤过率为(67.36±11.74)m L/1.73 m2·min,C组肾小球滤过率为(66.13±9.11)m L/1.73 m2·min,D组肾小球滤过率为(68.26±10.52)m L/1.73 m2·min,与治疗前比较,差异均有统计学意义(均P<0.01),但是各组间肾小球滤过率差异无统计学意义(P>0.05)。C组治疗28周的Pro为(0.38±0.05)g/24 h,治疗48周的Pro为(0.35±0.04)g/24 h,与D组的(0.20±0.06)g/24 h,(0.18±0.03)g/24 h比较,差异有统计学意义(P<0.01)。治疗15,28和48周后,A组与B组、C组与D组间血压差异均无统计学意义(P>0.05)。4组治疗期间均未发生药物过敏和肝肾功能损伤等药物不良反应。结论苯磺酸左旋氨氯地平和坎地沙坦酯在保护原发性高血压伴蛋白尿患者肾功能方面作用相似,但坎地沙坦酯在减少蛋白尿方面更有优势。Objective To compare the renal protective effect between calcium channel blocker levoamlodipine besylate and candesartan cilexetil in primary hypertension patients with proteinuria. Methods A total of208 patients were divided to four groups according to 24 h protein（ Pro）and different interventional medicines. Group A（ 1 g /24 h ≤ Pro 〈 3. 5g /24 h） treated by levoamlodipine besylate with 2. 5 mg·d-1. Group B（ 1 g /24 h≤Pro 〈 3. 5 g /24 h） treated by candesartan cilexetil with 4mg·d-1. Group C（ Pro 〈 1 g /24 h） treated by levoamlodipine besylate with 2. 5 mg ·d-1. Group D（ Pro 〈 1 g /24 h） treated by candesartan cilexetil with 4 mg·d-1. Every group was treated for 48 weeks. Blood pressure,glomerular filtration rate（ GFR） and Pro were measured beforeandafter treatment. Results After 24 weeks treatment,the GFR in A,B,C,D groups were（ 59. 42 ± 38. 11）,（ 60. 13 ±9. 72）,（ 58. 32 ± 10. 21）,（ 58. 73 ± 9. 41） m L /1. 73 m2· min; and were（ 66. 30 ± 81. 92）,（ 67. 36 ± 11. 74）,（ 66. 13 ± 9. 11）,（ 68. 26 ± 10. 52） m L/1. 73 m2·min after 48 weeks treatment,had significant difference with before treatment（ all P 〈 0. 01）. But there were no statistical significance among the four groups（ P 〉 0. 05）. Pro reduction at28 and 48 weeks were（ 0. 38 ± 0. 05） g /24 h,（ 0. 35 ± 0. 04） g /24 h in group C,had significant difference with group D,which were（ 0. 20 ± 0. 06） g /24 h,（ 0. 18 ± 0. 03） g /24 h（ P 〈 0. 01）. There was no significance in blood pressure between group A and group B,group C and group D at 15,28,48 weeks（ P 〉 0. 05）. The drug allergy and liver and kidney function injury did not occur during the treatment in four groups. Conclusion The renal protection efficacy of levoamlodipine besylate and candesartan cilexetil was similar in primary hypertensive patients with proteinuria. But candesartan cilexetil seemed to play a significant role of reduceing proteinuria in early renal dysfunction.

关 键 词：高血压 尿蛋白总量 钙通道阻滞药 血管紧张素Ⅱ1型受体拮抗药 

分 类 号：R972.4[医药卫生—药品]