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1.
目的评价缬沙坦与氨氯地平联合应用对高血压合并尿微量白蛋白患者肾功能的保护作用。方法回顾性分析高血压合并尿微量白蛋白的患者439例,分为氨氯地平组(A组)79例,缬沙坦组(B组)167例,缬沙坦和氨氯地平联合组(C组)193例。比较3组患者治疗1年后的血压、联合降压药物的数量、尿α1-微球蛋白、尿微量白蛋白、血清肌酐水平和肾小球滤过率等指标变化。结果与治疗前比较,A、B、C组患者治疗后收缩压和舒张压明显下降(P<0.05),B组和C组尿α1-微球蛋白和尿微量白蛋白明显下降(P<0.05)。B组联合用药最多。A组尿微量白蛋白变化差异无统计学意义(P>0.05)。C组血肌酐较A、B组患者明显下降,肾小球滤过率明显升高(P<0.05)。结论对于中老年高血压合并尿微量白蛋白患者,缬沙坦加氨氯地平联合治疗,可以达到强效降压和减轻蛋白尿双重目的 ,有利于延缓肾功能损害。  相似文献   

2.
选取2016年3月~2018年9月96例DN患者,随机平分为对照组给予厄贝沙坦治疗,观察组给予厄贝沙坦与贝前列素钠联合治疗3个月,比较两组不良反应发生情况。结果观察组治疗3个月后尿微量清蛋白(MAU)、24 h尿微量白蛋白(24 h-UMA)、MAU/尿肌酸酐(ACR)、β2微球蛋白(β2-MG)低于对照组(P 0. 05);观察组治疗3个月后内皮素-1(ET-1)、同型半胧氨酸(Hcy)低于对照组,一氧化氮(NO)高于对照组(P 0. 05);观察组不良反应发生率4. 17%与对照组6. 25%相比,(P 0. 05)。结论厄贝沙坦与贝前列素钠联合治疗高龄DN,能保护肾功能,纠正肾小球高滤过状态,减少蛋白尿,改善微循环障碍与血管内皮功能。  相似文献   

3.
目的 探讨冠心病患者肾功能的临床特征.方法 选择冠心病患者88例,按合并危险因素高血压、高血糖、高血脂三种中的一种、二种、三种、未合并分为4组,另设对照组.记录年龄、性别、体重、血肌酐、尿微量白蛋白、尿a1-微球蛋白,用简化肾脏病膳食改良公式(MDRD)计算肾小球滤过率(GFR).分析各组的变化.结果 冠心病患者的尿微量白蛋白、α1-微球蛋白增高,GFR降低;冠心病合并越多的危险因素,尿微量白蛋白、尿α1-微球蛋白增高越明显、GFR降低越明显.结论 冠心病早期出现肾脏损害,合并危险因素越多,损害越严重.  相似文献   

4.
目的探讨糖尿病早期肾损伤患者经尿微量蛋白检查的诊断价值与意义。方法选该院65例糖尿病早期肾损伤患者为对象(设为观察组)。而同期65例被确诊为单纯糖尿病患者作为对照组。检测2组患者的尿微量蛋白指标,并对比分析其结果。结果观察组微量白蛋白、α1-微球蛋白和免疫球蛋白G的值分别为(65.5±3.9)mg/L、(45.8±4.5)mg/L和(16.5±2.2)mg/L,而对照组分别为(19.7±3.3)mg/L、(11.4±2.8)mg/L和(6.2±1.4)mg/L,观察组在上述指标方面,均明显高于对照组,两组相比,差异有统计学意义(P0.05)。结论糖尿病早期肾损伤经尿微量蛋白检查诊断价值确切,尿微量白蛋白和α1-微球蛋白异常升高时,可将其当作肾损伤标志物。  相似文献   

5.
中西医结合治疗高血压肾损害的临床研究   总被引:1,自引:1,他引:1  
目的 运用中医益气固精,活血补肾法结合西药氯沙坦治疗高血压病肾损害患者,观察血压及相关实验室指标并加以评估分析.方法 收集60例高血压病肾损害患者,随机分为中西医结合组(治疗组)30例和西药组(对照组)30例,观察血压、肌酐、尿素氮、尿酸、血及尿β2-微球蛋白、尿微量白蛋白的变化,并作相关统计分析.结果 两组治疗后血压均较治疗前显著降低(P<0.05).两组时血及尿β2-微球蛋白、尿微量白蛋白均有显著改善(P<0.05),且治疗组血及尿β2-微球蛋白、尿微量白蛋白分别为(3.163±0.646)mg/L、(0.281±0.950)mg/L、(53.30±20.24)mg/L改善均优于对照组(P<0.05).结论 中西医结合治疗对高压病肾损害患者血及尿β2-微球蛋白、尿微量白蛋白有明显改善.  相似文献   

6.
目的探讨伊贝沙坦合用前列腺素E1对高血压病早期肾损害的作用.方法43例早期高血压病肾损害患者随机分为实验组(n=22)和对照组(n=21),先予以伊贝沙坦150 mg/d,治疗60 d后,实验组加用前列腺素E115 d.两组均在治疗前、治疗后60 d、治疗后75 d分别测定血清肌酐、24 h尿肌酐、24 h尿蛋白定量、晨尿查尿微量白蛋白和尿β2-微球蛋白、N-乙酰-β-D氨基葡萄糖苷酶(NAG)并计算肌酐清除率(CCr).结果两组治疗60 d后治疗前与治疗后相比肌酐清除率增加,24 h尿蛋白定量、尿微量白蛋白、β2微球蛋白均明显下降(P<0.05).而实验组尿β2微球蛋白、尿N-乙酰-β-D氨基葡萄糖苷酶在疗程结束后较治疗前和对照组均明显降低(P<0.05).结论伊贝沙坦合前列腺素E1对高血压病早期肾损害有保护作用,优于单一应用伊贝沙坦.  相似文献   

7.
目的观察厄贝沙坦氢氯噻嗪对老年高血压患者不同水平尿白蛋白的影响。方法选择2013年4月~2015年10月在我院老年医学科接受治疗的老年1级、2级高血压患者138例,根据24h尿白蛋白水平分为对照组35例、轻度升高组33例、重度升高组40例及临床蛋白尿组30例,皆给予口服厄贝沙坦150mg/d、氢氯噻嗪12.5mg/d连续治疗6个月,比较4组患者治疗前后尿白蛋白的变化。结果轻度升高组[(93.51±30.17)mg/24hvs(119.38±35.76)mg/24h,P0.01]和重度升高组[(199.63±21.85)mg/24hvs(237.64±17.09)mg/24h,P0.05]患者治疗后尿白蛋白水平较治疗前明显下降,差异有统计学意义;对照组[(19.89±5.26)mg/24hvs(20.35±4.52)mg/24h,P0.05]和临床蛋白尿组[(319.16±15.71)mg/24hvs(334.24±17.05)mg/24h,P0.05]患者治疗后尿白蛋白无显著差异。治疗后,轻度升高组患者的尿白蛋白变化率较重度升高组明显下降,差异有统计学意义[(-21.35±4.78)%vs(-15.63±2.63)%,P0.05]。结论厄贝沙坦氢氯噻嗪可有效减少老年轻、中度高血压患者的尿白蛋白,对较低程度蛋白尿及临床蛋白尿短期内无明显影响。  相似文献   

8.
目的探讨伊贝沙坦合用前列腺素E1对高血压病早期肾损害的作用.方法43例早期高血压病肾损害患者随机分为实验组(n=22)和对照组(n=21),先予以伊贝沙坦150mg/d,治疗60d后,实验组加用前列腺素E115 d.两组均在治疗前、治疗后60d、治疗后75d分别测定血清肌酐、24h肌酐、24h尿蛋白定量、晨尿查尿微量白蛋白和尿β2-微球蛋白、N-乙酰-β-D氨基葡萄糖苷酶(NAG)并计算肌酐清除率(CCr).结果两组治疗60d后肌酐清除率、24h尿蛋白定量、尿微量白蛋白治疗前与治疗后相比均明显下降(P<0.05).而实验组尿β2微球蛋白、尿N-乙酰-β-D氨基葡萄糖苷酶在疗程结束后较治疗前和对照组均明显降低(P<0.05).结论伊贝沙坦合前列腺素E1对高血压病早期肾损害有保护作用,优于单一用伊贝沙坦.  相似文献   

9.
目的探讨川芎嗪联合血管紧张素Ⅱ受体拮抗剂厄贝沙坦对高血压早期肾损害的防治效果。方法 108例轻、中度原发性高血压伴早期肾损害患者随机分为厄贝沙坦组(n=36)、川芎嗪组(n=36)及川芎嗪联合厄贝沙坦组(n=36),进行12周治疗。在治疗前后检测各组血α1-微球蛋白(α1-MG),血、尿β2-微球蛋白(β2-MG)水平并同时监测肾脏双侧叶段动脉(SRA)﹑叶间动脉(IRA)的收缩期峰速度(Vs)、舒张期末血流速度(Vd)、平均血流速度(Vm)、血流峰速加速时间(AT)、脉冲指数(PI)、阻力指数(RI)的变化并进行分析。结果川芎嗪组患者治疗前血α1-MG,血、尿β2-MG水平分别为(29.5±4.85)mg/L、(3860.7±313.2)μg/L、(186.3±15.1)μg/L,治疗后降为(19.0±4.11)mg/L、(3109.5±301.3)μg/L、(136.1±14.5)μg/L;厄贝沙坦组患者治疗前血α1-MG,血、尿β2-MG水平分别为(29.3±4.79)mg/L、(3845.4±307.1)μg/L、(185.5±14.7)μg/L,治疗后降低为(18.9±3.79)mg/L、(2985.4±290.9)μg/L、(135.9±14.1)μg/L;川芎嗪联合厄贝沙坦组患者治疗前血α1-MG,血、尿β2-MG水平分别为(29.6±4.82)mg/L、(3864.2±311.3)μg/L、(185.8±114.8)μg/L,治疗后降为(14.4±3.58)mg/L、(2107.6±282.5)μg/L、(105.3±13.9)μg/L;SRA、IRA的Vs、Vd、Vm增高(P〈0.05),AT缩短(P〈0.05),PI和RI降低(P〈0.05),以川芎嗪联合厄贝沙坦组改变最为明显。结论川芎嗪与厄贝沙坦均可对高血压早期肾损害发挥防治作用,两者联合使用防治效果更佳。  相似文献   

10.
目的分析探讨尿微量蛋白检测对于糖尿病早期肾损伤的诊断价值。方法依托样本分析法,该次研究样本数据来源:至该院接受干预治疗且取得其患者同意及支持的糖尿病早期肾损伤患者62例(干预组),同时选取同期至该院介绍健康检查且排除肾损伤疾病的62例糖尿病患者作为参照组,选取时间范围在2016年7月—2018年11月期间,观察对比入组患者的尿微量蛋白检测结果。结果干预组患者取得的α1-微球蛋白、尿微量白蛋白及免疫球蛋白G检测均值分别为(46.2±0.5)mg/L、(66.2±3.7)mg/L及(16.3±0.3)mg/L明显高于参照组的(12.2±0.3)mg/L、(20.1±3.1)mg/L及(5.8±1.1)mg/L,两组数据相比差异有统计学意义(P0.05)。结论尿微量蛋白检测可作为糖尿病早期肾损伤的临床诊断依据,可将α1-微球蛋白及尿微量白蛋白作为检测标志物,可帮助患者及早确诊肾损伤,诊断价值高。  相似文献   

11.

Background

Worsening renal function (WRF) associated with renin-angiotensin-aldosterone system (RAAS) inhibition does not confer excess risk in heart failure patients with reduced ejection fraction (HFrEF).

Objectives

The goal of this study was to investigate the relationship between WRF and outcomes in heart failure patients with preserved ejection fraction (HFpEF) and the interaction with RAAS blockade.

Methods

In 3,595 patients included in the I-PRESERVE (Irbesartan in Heart Failure With Preserved Ejection Fraction) trial, change in estimated glomerular filtration rate (eGFR) and development of WRF after initiation of irbesartan or placebo were examined. We examined the association between WRF and the first occurrence of cardiovascular death or heart failure hospitalization (primary outcome in this analysis) and the interaction with randomized treatment.

Results

Estimated GFR decreased early with irbesartan treatment and remained significantly lower than in the placebo group. WRF developed in 229 (6.4%) patients and occurred more frequently with irbesartan treatment (8% vs. 4%). Overall, WRF was associated with an increased risk of the primary outcome (adjusted hazard ratio [HR]: 1.43; 95% confidence interval [CI]: 1.10 to 1.85; p = 0.008). Although the risk related to WRF was greater in the irbesartan group (HR: 1.66; 95% CI: 1.21 to 2.28; p = 0.002) than with placebo (HR: 1.09; 95% CI: 0.66 to 1.79; p = 0.73), the interaction between treatment and WRF on outcome was not significant in an adjusted analysis.

Conclusions

The incidence of WRF in HFpEF was similar to that previously reported in HFrEF but more frequent with irbesartan than with placebo. WRF after initiation of irbesartan treatment in HFpEF was associated with excess risk, in contrast to WRF occurring with RAAS blockade in HFrEF.  相似文献   

12.
The aim of this study was to assess the effects of irbesartan alone and combined with amlodipine, efonidipine, or trichlormethiazide on blood pressure (BP) and urinary albumin (UA) excretion in hypertensive patients with microalbuminuria (30≤UA/creatinine (Cr) ratio [UACR] <300 mg/g Cr) and upper-normal microalbuminuria (10≤UACR<30 mg/g Cr). This randomized controlled trial enrolled 175 newly diagnosed and untreated hypertensive patients (home systolic blood pressure [SBP]≥135 mmHg; 10≤UACR<300 mg/g Cr of casual spot urine at the first visit to clinic). All patients were treated with irbesartan (week 0). Patients who failed to achieve home SBP ≤125 mmHg on 8-week irbesartan monotherapy (nonresponders, n = 115) were randomized into three additional drug treatment groups: trichlormethiazide (n = 42), efonidipine (n = 39), or amlodipine (n = 34). Irbesartan monotherapy decreased home SBP and first morning urine samples (morning UACR) for 8 weeks (p < 0.0001). At 8 weeks after randomization, all three additional drugs decreased home SBP (p < 0.0002) and trichlormethiazide significantly decreased morning UACR (p = 0.03). Amlodipine decreased morning UACR in patients with microalbuminuria based on casual spot urine samples (p = 0.048). However, multivariate analysis showed that only higher home SBP and UACR at week 8, but not any additional treatments, were significantly associated with UACR reduction between week 8 and week 16. In conclusion, crucial points of the effects of combination therapy on UACR were basal UACR and SBP levels. The effect of trichlormethiazide or amlodipine treatment in combination with irbesartan treatment on microalbuminuria needs to be reexamined based on a larger sample size after considering basal UACR and SBP levels.  相似文献   

13.
PURPOSE: In the present study, the objective is to determine the epidemiological risk factors in the appearance of diabetic retinopathy and nephropathy in 112 Type 1 diabetic patients after 15 years. METHODS: A 15-year follow-up study was done in a cohort of 112 consecutive Type 1 (IDDM) diabetes mellitus patients without diabetic retinopathy or nephropathy at enrolment in 1990. We studied the incidence of diabetic retinopathy and/or microalbuminuria. The epidemiological risk factors included in the study were gender, diabetes duration, HbA(1c) levels, arterial hypertension, levels of triglycerides and fractions of cholesterol (HDL-cholesterol and LDL-cholesterol). RESULTS: The incidence of diabetic retinopathy was 55.40% at the end of study; the risk factors associated were duration of diabetes mellitus (P<.001), high levels of HbA(1c) (P=.009), presence of arterial hypertension (P=.007) and high levels of LDL-cholesterol (P=.002). The incidence of microalbuminuria was 41.07% and that of overt nephropathy, 19.60%; the risk factors associated were high levels of HbA(1c) (P<.001) and presence of arterial hypertension (P=.023). At the end of study, four groups of patients were formed: patients without microalbuminuria or retinopathy, patients with microalbuminuria only, patients with retinopathy only and patients with retinopathy and microalbuminuria. From the results of the discriminate analysis, we may assume that for the development of retinal lesions only, in the diabetes mellitus, the duration of the disease, the high levels of HbA(1c) and the arterial hypertension are most important, and for the development of renal and retinal lesion simultaneously, the important factor is poor control of glycemia measured by levels of HbA(1c) and arterial hypertension. CONCLUSIONS: In conclusion, microalbuminuria correlated well with severe forms of diabetic retinopathy, and at the end of the study, two groups of patients had been configured: the first group had developed only diabetic retinopathy, and the second, their patients with diabetic retinopathy together with renal lesion (microalbuminuria). For the first group, the duration of diabetes mellitus was the most important risk factor, and for the second group, the levels of HbA(1c) and blood pressure were the most important.  相似文献   

14.
The relationship between cardiovascular and renal pathologies is well recognized in advanced nephropathy and heart failure, but in early disease it has received less attention. Consequently, microalbuminuria screening and interventions that treat early nephropathy remain under-utilized cardioprotective strategies in the hypertensive patient. Agents that delay the progression of renal disease are likely to be cardioprotective by lessening the systemic consequences of renal dysfunction and may have additional cardioprotective effects by exerting beneficial effects on endothelia elsewhere in the body and within the heart. A critical driving factor within both renal and wider cardiovascular pathologies is overactivation of the renin-angiotensin-aldosterone system (RAAS). Accordingly, RAAS-directed antihypertensive agents including both angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have been demonstrated to have renoprotective effects. In major prospective trials, two ARBs, losartan and irbesartan, have been demonstrated to be renoprotective in patients with frank proteinuria, and one ARB, irbesartan, has been shown to have renoprotective properties in patients with microalbuminuria. For patients with incipient or frank renal dysfunction, an aggressive RAAS-based approach to hypertension management, combining potent blood pressure control with proven renoprotection, may therefore constitute a key component of therapy targeted towards long-term cardioprotection.  相似文献   

15.
Therapy with losartan compared to irbesartan was performed in a Chinese sample of hypertensive patients with elevated serum uric acid (SUA) levels. After 1 week of screening and a 2 week single-blinded placebo baseline period, patients were treated for 4 weeks with losartan 50 mg or irbesartan 150 mg. After 4 weeks, patients with SiDBP <90 mmHg and SiSBP <140 mmHg continued the same dose regimen for another 4 weeks. If blood pressure was not controlled after 4 weeks of treatment, the dose of either regimen was doubled to losartan 100 mg and irbesartan 300 mg. There were 351 patients randomized (176 to losartan and 175 to irbesartan), and of these, 325 patients completed the study (162 in the losartan group and 163 in the irbesartan group). At baseline, the median SUA level in the losartan group was 422 and 420 micromol/l in the irbesartan group. At 8 weeks of therapy, SUA decreased by 63 mumol/l in the losartan group compared to 12 mumol/l in the irbesartan group (P < 0.0001). Blood pressure declined comparably in both groups from 151/92 mmHg at baseline to 137/83 and 135/83 (losartan and irbesartan, respectively, NS). No severe AEs were found for either treatment group. Therapy with losartan decreased SUA levels significantly more than irbesartan in Chinese patients with hypertension and elevated SUA levels, demonstrating the unique uricosuric effect of this ARB in this ethnic group.  相似文献   

16.
目的观察厄贝沙坦和卡维地洛联合治疗高血压的效果。方法300例高血压患者,根据动态血压结果,按照夜间血压下降率<10%为非杓型组,≥10%为杓型组。给与卡维地洛和厄贝沙坦联合治疗6个月。观察治疗前后动态血压和心脏结构及功能的变化。结果高血压存在着明显的昼夜节律。非杓型组与杓型组相比左心室质量、左心室质量指数及左心房内径、舒张功能障碍明显增加。治疗后,非杓型组昼夜节律恢复,心室质量、心脏舒张功能均有明显改善。结论卡维地洛和厄贝沙坦联合可以恢复高血压患者的昼夜节律,减轻心肌重塑,改善舒张功能。  相似文献   

17.
目的探讨厄贝沙坦治疗充血性心力衰竭的临床疗效及安全性。方法采用随机、单盲、自身对照及组间对照方法。观察组52例,服用厄贝沙坦,平均(75±15)mg╱d,对照组37例。疗程均为6个月。观察二组治疗前后临床疗效:左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVEDV),6min步行试验及心肌耗氧量。结果其相关参数差异均有高度显著性(P<0.01)。观察组再住院率及病死率明显减少(P<0.025)。二组治疗前后及组间比较肾功能、血糖、血脂、血钾的差异均无显著性(P>0.05)。结论 厄贝沙坦治疗非瓣膜病充血性心力衰竭临床疗效显著且安全,值得临床推广使用。  相似文献   

18.
目的探讨厄贝沙坦/氢氯噻嗪对原发性高血压伴早期肾损害患者尿微量白蛋白(mALB)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG酶)影响。方法将80例原发高血压(1~2级)伴早期肾损害患者按就诊顺序随机分为厄贝沙坦/氢氯噻嗪组40例和硝苯地平控释片组40例,均服药12周。观察两组用药前后血压、尿mALB、NAG酶、肾功能、血糖、血脂、血钾的变化。结果两组经12周治疗后血压均较治疗前明显降低(P<0.01),但两组治疗后血压比较,差异无统计学意义(P>0.05);两组治疗前后肾功能、血糖、血脂、血钾比较,差异无统计学意义(P>0.05);两组尿mALB、NAG酶均较治疗前降低(P<0.05),厄贝沙坦/氢氯噻嗪组明显优于硝苯地平控释片组(P<0.05)。结论厄贝沙坦/氢氯噻嗪具有良好的降压作用,同时能降低尿mALB、NAG酶的水平,改善肾功能。  相似文献   

19.
Endothelin has been identified as a potent vasoconstrictor. The aim of this study was to evaluate urinary endothelins and their relation to other markers of renal damage, such as microalbuminuria, creatinine, and N-acetyl-β-glucosaminidase (NAG), in a group of recently diagnosed (less than 1 year) hypertensive subjects and a control group. We selected 50 subjects and divided them into two groups: 27 hypertensive patients (15 females and 12 males) without previous pharmacologic therapy, and 23 healthy, normotensive subjects (12 females and 11 males). All patients underwent a history and physical examination, chest x-ray, electrocardiography, funduscopy, and hematologic and biochemical analyses. Endothelins, microalbuminuria, creatinine, and NAG values were also determined in 24-hour urine samples. Creatinine, microalbuminuria, and NAG values were found to be higher in hypertensive than in normotensive subjects. The hypertensive group showed a nonsignificant elevation of total endothelin. In conclusion, the determination of elevated urinary endothelin does not appear to be an early marker of organ damage in hypertensive subjects. The urinary excretion of protein, creatinine, and NAG was higher in hypertensive subjects. A positive correlation was found between the urinary excretion of endothelins and markers of renal damage, microalbuminuria and NAG values. The relationship between endothelins and hypertension was without statistical significance.  相似文献   

20.
非洛地平和伊贝沙坦对原发性高血压左室肥厚的逆转作用   总被引:2,自引:0,他引:2  
目的 :观察非洛地平和伊贝沙坦治疗原发性高血压 (EH)的疗效及对左室肥厚的作用。方法 :将 10 4例EH伴左室肥厚的患者随机分为非洛地平组和伊贝沙坦组 ,于服药前及服药后 6个月、12个月、2 4个月分别测定血压、左室舒张末内径 (LVDd)、舒张期室间隔厚度 (IVST)、左室后壁厚度 (LVPWT)、左室射血分数 (LVEF)、左室高峰射血率 (LPER)、左室高峰射血率时间 (LTPER)、左室高峰充盈率 (LPFR)和左室高峰充盈率时间(LTPFR)。结果 :治疗后 ,两组血压较治疗前显著下降 (P <0 .0 5 ,或P <0 .0 1) ,两组治疗前后比较LVEF、LPER和LTPER均无变化 (P >0 .0 5 ) ,而LPFR升高和LTPFR则明显降低 (P <0 .0 5 ,或P <0 .0 1) ;左室重量指数 (LVMI)、LVDd、IVST、LVPDWT在伊贝沙坦组明显下降 (P <0 .0 5 ,或P <0 .0 1) ,而在非洛地平组则无变化 (P >0 .0 5 )。结论 :非洛地平和伊贝沙坦均能有效控制血压 ,但伊贝沙坦能明显减轻左室肥厚  相似文献   

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