A型性格对中老年原发性高血压患者早期肾功能损害的影响及贝那普利的保护作用

目的 探讨A型性格对中老年原发性高血压患者早期肾功能损害的影响及贝那普利对其的保护作用.方法 根据A型性格量表,在中老年原发性高血压患者中筛查出80例A型性格(A型性格组)和80例非A型性格(非A型性格组),给予贝那普利干预治疗,初始计量10 mg/d,剂量递增,使血压达标,在1个月内使最大剂量增至20 mg/d,服药6个月.采集一般临床资料并分别在治疗前、后测定患者血浆的血管紧张素Ⅱ(AngⅡ)、尿微量白蛋白排泄率(UAER)、尿β2-微球蛋白(β2-MG).结果 两组年龄、性别、体质指数(BMI)、尿素(BUN)、肌酐(Cr)、收缩压及舒张压差异无统计学差异(均P>0.05).A型性格组较非A型性格组AngⅡ(60.3±11.6)mg/L与(55.8±10.2)mg/L]、UAER(83.3±23.3)μg/min与(75.7±16.3)μg/min]、β2-MG(75.6±24.5)mmol/L与(66.0±19.4)mmol/L]增高,差异均有统计学意义(t值分别为2.598、2.603、2.742,P值分别为0.016、0.012、0.008);2组的A型性格分值与AngⅡ、UAER、β2-MG呈正相关(r值分别为0.361、0.198和0.202,P值分别为0.002、0.015、0.021),经多元逐步回归分析,AngⅡ为其独立危险因素(β=0.291,t=2.793,P=0.008).用药后2组的收缩压、舒张压、AngⅡ、UAER及β2-MG均显著下降,并且2组中AngⅡ的变化值与UAER(r=0.373,P=0.005;r=0.282,P=0.032)及B2-MG(r=0.385,P=0.003;r=0.279,P=0.039)的变化值亦呈正相关.结论 A型性格可通过应激系统加重中老年原发性高血压患者早期肾功能损害,贝那普利对其具有较好的保护作用.

Influence of type A character on early renal impairment in elderly patients with essential hypertension and the protective effect of benazepril

Objective To explore the influence of type A character on early renal impairment in elderly patients with essential hypertension and the protective effect of benazepril. Methods According to the type A behavior measuring scale, 80 cases with type A character and 80 cases without type A character were screened out from the elderly patients with essential hypertension. The patients received benazepril intervention with incipient dose of 10 mg daily, which increased gradually to the largest does of 20 mg daily within 1 month, The treatment lasted 6 months in order to make the patients achieve the normal blood pressure (BP). The general data, plasma angiotensin Ⅱ (AngⅡ )> urinary albumin excretion rate (UAER) and urinary β2-microglobulin (β2-MG) were measured at pretherapy and post-treatment respectively. Results There were no statistically significant differences at pretherapy between the two groups in age, gender, body mass index (BMI), blood urea nitrogen (BUN), creatinine (Cr), systolic pressure and diastolic pressure (all P>0.05). Ang Ⅱ (60.3±11.6)mg/Lvs (55.8±10.2)mg/L], UAER(83.3±23.3)μg/min vs. (75.7±16.3)μg/min] and β2-MG (75.6±24.5)mmol/L vs. (66.0±19.4)mmol/L] were significantly higher in type A character group than in non-type A character group (t=2.598, 2.603, 2.742; P= 0.016,0.012, 0.008). TypeA character value of the two groups showed a positive correlation with Ang Ⅱ (r= 0.361, P=0.002), UAER (r=0.198, P=0.015) and β2-MG (r=0.202, P = 0.021). Only Ang Ⅱ (β=0.291, t=2.793, P= 0.008) was correlated to type A character value independently by multiple stepwise regression analysis. Before treatment in both of the type A character group and the non-type-A character group, there was a positive correlation between Ang II and UAER, (β2-MG, and obvious correlation in type-A character group. The systolic pressure, diastolic pressure, Ang Ⅱ , UREA and β2-MG were all decreased obviously in two groups post treatment. And the variable value of AngⅡ was also positively correlated with UAER (r=0.373, P=0.005; r=0.282, P=0.032), fr-MG (r= 0.385, P=0.003; r= 0.279, P=0.039) before and after treatment. Conclusions Type A character can aggravate injury of early renal function by certain stress systems in the elderly patients with essential hypertension and benazepril has better protective effect for it.