硝苯地平联合盐酸贝那普利对慢性肾性高血压患者骨密度的影响  

Effect of Nifedipine Combined with Benazepril Hydrochlorideon on Bone Mineral Density of Chronic Renal Hypertension Patients

作　　者：陈橙[1] 周建松[2] 

机构地区：[1]东南大学附属中大医院江北院区肾内科,南京210044 [2]东南大学附属南京江北人民医院心内科,南京210048

出　　处：《医学综述》2016年第24期4932-4936,共5页Medical Recapitulate

基　　金：南京市医学科技发展项目(YKK12212)

摘　　要：目的探讨慢性肾性高血压患者应用硝苯地平联合盐酸贝那普利治疗后对骨密度的影响。方法选取2012年3月至2015年12月东南大学附属中大医院江北院区收治的180例慢性肾性高血压患者为研究对象,采用随机数字法将患者分为硝苯地平组、贝那普利组及联合组,每组60例。硝苯地平组给予硝苯地平片口服治疗(每次30 mg,每日1次);贝那普利组给予盐酸贝那普利口服治疗(每次10~20 mg,每日1次);联合组在硝苯地平组基础上应用盐酸贝那普利口服,疗程为6个月。比较三组患者治疗后收缩压、舒张压、24 h尿蛋白定量及血肌酐水平;治疗前后分别测定三组研究对象血清骨特异性碱性磷酸酶(BALP)、Ⅰ型胶原C端肽(CTX)、抗酒石酸酸性磷酸酶(TRAP)水平,血清游离钙(Ca^(2+))、血清磷(P^(3+))水平,股骨颈和跟骨的骨密度以及骨折发生率。结果治疗后,三组患者的收缩压、舒张压及血肌酐水平比较,差异无统计学意义(P>0.05);联合组24 h尿蛋白定量水平显著低于贝那普利和硝苯地平组,差异有统计学意义(P<0.05)。治疗后三组间CTX、TRAP以及BALP水平比较差异有统计学意义,其中硝苯地平组CTX、TRAP水平高于贝那普利组和联合组,而BALP水平低于贝那普利组和联合组,差异有统计学意义(P<0.05),而联合组CTX、BALP及TRAP水平与贝那普利组相比差异无统计学意义(P>0.05);治疗后,联合组的Ca^(2+)水平高于硝苯地平组和贝那普利组,贝那普利组高于硝苯地平组,差异有统计学意义(P<0.05);联合组P3+水平与贝那普利组比较差异无统计学意义(P>0.05);硝苯地平组P3+水平显著低于贝那普利组和联合组,差异有统计学意义(P<0.05)。治疗后,硝苯地平组骨折发生率为11.7%,贝那普利组骨折发生率为8.3%,而联合组骨折发生率为3.3%,三组比较差异有统计学意义(P<0.05)。治疗后联合组和贝那普利组股骨颈的骨密度显著高于硝苯地平组(P<0.Objective To explore the effect of nifedipine combined with benazepril hydrochloride on bone mineral density in patients with chronic renal hypertension. Method Total of 180 patients with hypertension of chronic kidney disease in Jiangbei District Hospital of Zhongda Hospital Affiliated to Southeast University from Mar. 2012 to Dec. 2015 were included as the research objects, and then randomly divided into a nifedipine group, a combination group and a benazepril group, 60 cases in each group. The nifedipine group was giver, oral nifedipine treatment （30 mg each time, 1 time daily） ,the benazepril group was given oral benazepril hydrochloride（ 10-20 mg each time, 1 time daily）, and the combination group was given oral nifedipine and benazepril hydrochloride. All the patients were treated for 6 months. The systolic blood pressure, diastolic blood pressure,24 h urine protein and serum creatinine level of the three groups were compared, serum bone specific alkaline phosphatase（ BALP）, collagen type C N-terminal peptide（CTX） and tartrate resistant acid phosphatase（TRAP） levels, serum free calcium（ Ca2 ＋ ） , serum phosphorus level （p3＋ ） ,femoral neck and calcaneus bone density and fracture incidence of the patients were determined before and after treatment. Results After treatment,the systolic blood pressure, diastolic blood pressure and serum creatinine level of the three groups had no statistically significant differences （P 〉 0. 05 ） ;24 h urinary protein level of the eombination group was significantly lower than that of thenifedipine group.and benazepril group ,with statistically significant differences（ P 〈 0.05 ）. After treatment, the CTX, TRAP and BALP levels of the three groups were statistcally significantly different, the CTX, TRAP levels of the nifedipine group were higher than the benazepril group and combination group, BALP level was lower than the benazepril group and combination group （ P 〈 0. 05 ）, but there was no statistically significant difference

关 键 词：肾性高血压 硝苯地平 盐酸贝那普利 骨质疏松 

分 类 号：R673.3[医药卫生—外科学]