长期利尿剂与限钠法在治疗慢性肾病高血压患者中的应用  

Application of Long-Term Diuretics and Sodium Restriction in the Treatment of Patients with Chronic Kidney Disease and Hypertension

作　　者：林武君 陈德政[1] 彭李[1] Lin Wujun;Chen Dezheng;Peng Li(Department of Nephrology,Jianyang People's Hospital,Jianyang,Chengdu,Sichuan 641400,China)

机构地区：[1]简阳市人民医院肾内科,四川成都641400

出　　处：《四川医学》2024年第4期415-421,共7页Sichuan Medical Journal

摘　　要：目的 探讨长期利尿剂与限钠法在治疗慢性肾病(CKD)高血压患者的应用效果。方法 选取2019年9月至2021年3月我院肾内科收治的26例CKD高血压患者,所有患者均接受阿米洛利/氢氯噻嗪(每天5 mg/50 mg)和膳食钠(60 mmol/d)限制治疗。分析两种干预措施对血压、肾功能和体液平衡的影响,将其与利尿剂的肾脏清除率相关联。结果 饮食钠限制将钠排泄从每天160 mmol/L减少到64 mmol/L;与钠限制(SBP从134 mmHg到129 mmHg)相比,利尿剂使24 h平均收缩压(SBP从138到124 mmHg)产生更大的降低作用,并且对细胞外水、肾小球滤过率(eGFR)、血浆肾素和醛固酮有显著影响;两种干预措施都导致体质量和氨基末端脑钠肽前体下降,没有显著降低白蛋白尿,而利尿剂却显著降低了尿血管紧张素原和β2-微球蛋白的排泄;尽管较低的eGFR和较高的血浆硫酸吲哚酚与较低的利尿剂清除率相关,但在较低的eGFR下仍维持了对体质量和血压的利尿作用。在利尿剂治疗期间,较高的前列腺素E2排泄与较低的游离水清除率相关,4例患者出现轻度低钠血症。结论 长期利尿剂在降低CKD的血压和细胞外容量方面不劣于饮食钠盐限制。尽管利尿剂清除率较低,但CKD患者仍能维持对利尿剂的敏感性。Objective To explore application of long-term diuretics and sodium restriction in the treatment of patients with chronic kidney disease and hypertension(CKD).Methods From September 2019 to March 2021,26 patients with chronic primary nephropathy and hypertension who were treated in our hospital were selected.They were treated with amiloride/hydrochlorothiazide(5 mg/50 mg per day)and dietary sodium(60 mmol/d).Effects on blood pressure,renal function and fluid balance were analyzed and correlated with the renal clearance rate of diuretics.Results Dietary sodium restriction reduced sodium excretion from 160 mmol/L to 64 mmol/L per day.Compared with sodium restriction(SBP from 134 mmHg to 129 mmHg),diuretics caused 24 h average systolic blood pressure(SBP from 138 to 124 mmHg)produced a greater reduction,and had a significant impact on extracellular water,glomerular filtration rate(eGFR),plasma renin and aldosterone.Both interventions resulted in body weight and N-terminal brain Pre-natriuretic peptide(NT-proBNP)decreased and did not significantly reduce albuminuria,while diuretics significantly reduced excretion of urinary angiotensinogen andβ2-microglobulin.Despite the lower eGFR and higher plasma indoxyl sulfate was associated with a lower diuretic clearance rate,but still maintained a diuretic effect on body weight and blood pressure at a lower eGFR.During diuretic treatment,higher PGE2 excretion was associated with lower free water clearance,and 4 patients developed mild hyponatremia.Conclusion Long-term diuretics are not inferior to dietary sodium restriction in reducing blood pressure and extracellular volume of CKD.Although diuretic clearance is low,patients with CKD stll maintain diuretic sensitivity.

关 键 词：长期利尿剂 限钠法 慢性肾病高血压 肾脏清除率 

分 类 号：R544.1[医药卫生—心血管疾病]