曲美他嗪对高血压肾病患者肾功能影响的相关临床研究

目的 探讨曲美他嗪对高血压肾病患者肾功能的影响.方法 采用前瞻性随机双盲对照研究方法,收集2011年6月至2014年1月入住广州市红十字会医院心内科的高血压肾病患者共102例,按照随机数字表法分为对照组和曲美他嗪治疗组.两组患者均接受降压治疗,治疗组加用曲美他嗪20 mg口服,每日3次,均治疗14天.于治疗前、治疗后7天、治疗后14天测定血肌酐（SCr）、尿素氮（BUN）、胱抑素C,计算肌酐清除率（CCr）及24 h尿蛋白,同时监测患者血压情况.结果 两组患者治疗前肾功能指标差异均无统计学意义,平均动脉压及24 h尿蛋白差异无统计学意义.治疗7天后,治疗组较对照组SCr（101.77± 19.02） vs（118.23± 18.11）,P＜0.05]、胱抑素C（0.85±0.61） vs（1.01±0.89）,P＜ 0.05]、尿素氮（9.04±4.77）vs（11.12±3.27）,P＜0.05]及24 h蛋白尿（0.46±0.42） vs（0.58±0.51）,P＜ 0.05]有下降,肌酐清除率（57.49±27.42） vs（41.22±13.23）,P＜0.05]有所升高,差异均有统计学意义;两组平均动脉压（79.28±19.55）vs（77.54±20.14）,P＞0.05]差异无统计学意义.治疗14天后,两组平均动脉压（72.33±20.78） vs（71.78±21.48）,P＞0.05）]、尿素氮（8.87±3.18）vs（9.46±8.24）,P＞0.05]差异无统计学意义;SCr（110.86±23.24）vs（90.53±18.31）,P＜0.05]、胱抑素C（0.77±0.47）vs（0.53±0.24）,P＜0.05]及24 h尿蛋白（0.54±0.47） vs（0.23±0.21）,P＜ 0.05]治疗组低于对照组,治疗组肌酐清除率（72.22±19.78）vs（65.97±24.32）,P＜0.05]明显高于对照组,差异有统计学意义.结论 曲美他嗪可以改善高血压肾病患者的肾功能.

The effect of trimetazidine on renal function in patients with hypertensive nephropathy

Objective To investigate the effect of trimetazidine on renal function in patients with hypertensive nephropathy.Methods This study was a prospective,random,double blind,observational study.102 cases of hypertensive nephropathy admitted in department of cardiology of Guangzhou Red Cross Hospital from June 2011 to January 2014 were randomly divided into control group and trimetazidine treatment group.All patients received anti-hypertensive therapy,patients in treatment group received trimetazidine treatment （20 mg,po tid） for 14 days.Data of serum creatinine,blood urea nitrogen,cystatin C,creatinine clearance and 24 hour urine protein which reflected renal function were collected in both groups and compared at the time point of before treatment,7 and 14 days after treatment.At the same time monitored blood pressure of patients.Results Before the treatment,there were no statistically significant differences in cystatin C,serum creatinine,blood urea nitrogen,creatinine clearance,mean arterial pressure and 24 hour urine protein between two groups （P 〉 0.05）.7 days after treatment,serum creatinine,blood urea nitrogen,cystatin C and 24 hour urine protein in treatment group were lower than those in control group （101.77 ± 19.02） vs.（118.23 ± 18.11）; （9.04 ± 4.77） vs.（11.12 ± 3.27）;（0.85 ± 0.61） vs.（1.01 ± 0.89）; （0.46 ± 0.42） vs.（0.58 ± 0.51）; P 〈 0.05],while creatinine clearance higher than that in control group （57.49 ± 27.42） vs.（41.22 ± 13.23）; P 〈 0.05],no statistically significant difference in MAP between two groups （72.33 ± 20.78） vs.（71.78 ± 21.48）; P 〉 0.05].14 days after treatment,there were no statistically significant differences in MAP and blood urea nitrogen between two groups （72.33 ± 20.78） vs.（71.78 ± 21.48）; （8.87 ± 3.18） vs.（9.46 ± 8.24）; P 〉 0.05],serum creatinine,cystatin C and 24 hour urine protein in treatment group lower than those in control group （110.86 ± 23.24） vs.（90.53 ± 18.31）; （0.77 ± 0.47） vs.（0.53 ± 0.24）; （0.54 ± 0.47） vs.（0.23 ± 0.21）; P 〈 0.05],while creatinine clearance in treatment group higher than that in control group （65.97 ± 24.32） vs.（72.22 ± 19.78）; P 〈 0.05].Conclusion Trimetazidine can improve renal function in patients with hypertensive nephropathy.