双倍剂量厄贝沙坦治疗老年高血压合并慢性肾脏病的疗效观察

目的探讨双倍剂量厄贝沙坦对老年高血压合并慢性肾脏病患者的临床疗效及安全性。方法入选90例高血压合并慢性肾脏病的老年患者随机分为观察组(n=45例)及对照组(n=45)。观察组予双倍剂量厄贝沙坦300mg/d,对照组予常规剂量厄贝沙坦150mg/d治疗,3个月后比较两组血压、尿蛋白定量、肝功能、尿酸、血肌酐及电解质等指标变化。结果治疗3个月后,观察组血压达标率为62.22%,明显高于对照组17.78%(P0.05);24h尿蛋白下降幅度(1.51±0.13)g/24h,明显大于对照组(0.04±0.01)g/24h(P0.05)。两组均未出现转氨酶异常、尿酸增高、血肌酐升高、高钾血症等不良反应。结论双倍剂量厄贝沙坦治疗高血压合并慢性肾脏病老年患者安全有效,能有效控制血压,显著减轻尿蛋白,在降压的同时保护肾脏。     

羟苯磺酸钙联合厄贝沙坦逆转早期糖尿病肾病的作用

目的探讨羟苯磺酸钙联合厄贝沙坦治疗早期糖尿病肾病(DN)的临床疗效。方法 210例早期DN患者随机分为A、B、C 3组,每组70例。A组口服厄贝沙坦,0.15 g/片,1次/d;B组口服羟苯磺酸钙,0.5 g/片,口服,3次/d;C组口服羟苯磺酸钙联合厄贝沙坦,剂量和每日次数同前两组。3组疗程均为24 w。比较3组治疗前后的24 h尿蛋白定量测定、尿白蛋白与尿肌酐比值(ACR)、尿β2-微球蛋白(MG)、血肌酐(Scr)、尿素氮(BUN)、空腹血糖(FBG)、餐后2 h血糖(2 h PG)水平。结果治疗后,C组24 h尿蛋白定量明显低于A组和B组(P0.05);C组ACR明显低于A组和B组(P0.05);C组尿β2-MG明显低于A、B组(P0.05);而治疗前后3组Scr、BUN、FBG、2 h PG差异均无统计学意义(P0.05)。结论羟苯磺酸钙联合厄贝沙坦治疗早期DN可进一步减少尿蛋白,延缓肾脏疾病的进展,对早期逆转起到一定作用。     

丹参联合厄贝沙坦治疗早期糖尿病肾病临床观察

目的观察丹参联合厄贝沙坦治疗早期糖尿病肾病的临床疗效。方法将60例早期糖尿病肾病（DN）患者随机分为两组,对照组：口服厄贝沙坦150 mg,1次/d,疗程1月;治疗组：在对照组基础上用丹参冻干粉针800 mg加入0.9%氯化钠注射液250 ml中静脉滴注,1次/d,1月为1个疗程。观察比较治疗前后两组患者24 h尿微量白蛋白（UMA）、总胆固醇、甘油三酯、糖化血红蛋白、血压、尿素氮、血肌酐、空腹血糖、尿蛋白排泄率。结果两组24 h尿微量白蛋白、血脂、糖化血红蛋白（HbA1c）、血压、尿素氮、血肌酐、空腹血糖、尿蛋白排泄率均下降,但治疗组下降幅度大于对照组,差异有统计学意义（P〈0.05）。结论丹参冻干粉针联合厄贝沙坦治疗早期糖尿病肾病,在降低血压、血脂及HbA1c的同时,又可改善早期DN患者的血液流变学、微循环,显著降低24 h UMA的排出,减少尿蛋白,减轻肾损害,延缓其发展为终末期肾病,改善糖尿病患者的预后和生存质量。     

缬沙坦单药及伍用中药治疗慢性肾小球肾炎疗效及安全性比较

目的比较缬沙坦单药及伍用中药治疗慢性肾小球肾炎的临床疗效及安全性。方法 120例慢性肾小球肾炎病人随机分为单药组和联合组,单药组仅口服缬沙坦,联合组同时口服缬沙坦和黄葵。治疗8周后评价治疗有效率和安全性,比较治疗前后患者血肌酐、尿素氮和24 h尿蛋白含量。结果联合组治疗慢性肾小球肾炎总体有效率(90.0%)显著高于单药组(63.3%)(χ~2=11.93,P<0.01);两组患者治疗后血肌酐、尿素氮和24 h尿蛋白含量均较治疗前显著改善(P均<0.05),且联合组患者改善更为明显。两组患者不良反应发生率差异无统计学意义(校正χ~2=0,P>0.05)。结论缬沙坦伍用黄葵治疗慢性肾小球肾炎效果显著高于缬沙坦单药治疗,且不良反应与单用无显著差异。缬沙坦伍用黄葵治疗慢性肾小球肾炎安全、高效,值得临床推广应用。     

不同剂量缬沙坦治疗合并高血压的慢性肾小球肾炎疗效研究

目的 评价常规剂量与高剂量的缬沙坦对慢性肾小球肾炎合并高血压的肾脏保护作用.方法 将2004年3月至2006年1月中南大学湘雅二医院肾内科住院的30例慢性肾小球肾炎患者随机分为常规剂量组(n=15)和高剂量组(n=15),常规剂量组口服缬沙坦160mg/d,高剂量组口服缬沙坦320 mg/d,疗程6个月.观察24 h尿蛋白、血压、血清肌酐、估算肾小球滤过率(GFR)及血钾的变化.结果 两组患者的基线临床资料基本相似,6个月后,两组患者的血压控制差异无统计学意义,常规剂量组血清肌酐(Scr)从(141±53)μmol/L升至(186±61)μmol/L,GFR从(68±30)mL/min降至(6l±32)mL/min;而高剂量组Scr[(141±62)μmoL/L到(142±71)μmol/L]和GFR[(67±38)mL/min到(69±38)mL/min]在观察期间无明显改变;高剂量组蛋白尿下降更为显著(P<0.05);两组血清钾均无明显改变.结论 对慢性肾小球肾炎伴高血压的患者,高剂量缬沙坦在减少蛋白尿、延缓慢性肾功能衰竭的进展方面更为有效.     

厄贝沙坦联合激素治疗紫癜性肾炎的临床疗效研究

目的：研究厄贝沙坦联合激素治疗紫癜性肾炎的临床疗效 方法：选择2010年5月至2014年2月我院收治的88例紫癜性肾炎患者,按照随机数表法将所有患者分为厄贝沙坦治疗观察组(44例)和激素治疗对照组(44例)。观察两组患者的蛋白尿、血尿、高血压、以及水肿等临床症状的消失时间；分析比较两组患者在治疗前后的24h尿蛋白、尿红细胞数、血尿素氮、以及血肌酐的变化情况；对两组患者的临床疗效进行评定。结果：观察组蛋白尿、血尿、高血压、水肿临床症状的消退时间分别为(17.1±3.4)d、(30.4±5.7)d、(7.1±1.8)d和(6.5±1.7)d显著短于对照组的(23.4±4.8)d、(42.8±8.9)d、(10.9±2.1)d和(10.4±2.5)d(P<0.05)。两组患者在治疗前24h尿蛋白、尿红细胞数、血尿素氮、以及血肌酐各项指标无显著性差异(P>0.05),经治疗后两组上述指标均出现显著减低(P<0.05和P<0.01)。观察组的24h尿蛋白、尿红细胞数、血尿素氮、以及血肌酐的改善显著优于对照组(P<0.05和P<0.01)。观察组患者治疗总的有效率为95.45%,显著高于对照组的70.45%(P<0.05)。结论：厄贝沙坦联合激素治疗紫癜性肾炎的临床疗效较好,症状消退时间短,不良反应少,优于单纯激素治疗,值得推广使用。     

阿魏酸哌嗪联合厄贝沙坦治疗早期糖尿病肾病52例

2016年2月-2017年3月104例早期DN患者平分对照组用厄贝沙坦治疗;联合用药组给予阿魏酸哌嗪联合厄贝沙坦治疗。结果:联合用药组效果比对照组高,P 0. 05;尿蛋白24小时定量、尿素氮比对照组低,血肌酐清除水平高于对照组,P 0. 05;两组均无明显不良反应,P0. 05。结论:阿魏酸哌嗪联合厄贝沙坦治疗早期DN效果确切,可改善肾功能。     

厄贝沙坦联合甲基泼尼松龙冲击治疗系膜增生性肾小球肾炎70例疗效观察

目的 探讨厄贝沙坦联合甲基泼尼松龙冲击治疗系膜增生性肾小球肾炎（MsPGN）的疗效。方法 将同期收治的120例MsPGN患者随机分为观察组70例和对照组50例,对照组予甲基泼尼松龙0．8mg／（kg·d）口服;观察组予厄贝沙坦200mg／d口服及甲基泼尼松龙0.5g静滴,3d后甲基泼尼松龙改为口服、剂量同上,两组疗程均为4周。治疗前后分别测定两组血清及尿白蛋白（Alb）、24h尿蛋白定量并据此判定疗效。结果观察组完全缓解40例、显著缓解26例、部分缓解4例、总缓解率为100％,对照组完全缓解16例、显著缓解14例、部分缓解14例、无效5例、总缓解率为90％,观察组总缓解率显著高于对照组（P〈0．05）。结论厄贝沙坦联合甲基泼尼松龙冲击治疗MsPGN可明显改善患者临床症状、体征,提高临床总缓解率。     

厄贝沙坦联合黄葵胶囊治疗2型糖尿病肾病的疗效观察

目的观察应用厄贝沙坦联合黄葵胶囊治疗2型糖尿病肾病的疗效。方法将2012年8月—2015年12月该院收治的48例2型糖尿病肾病患者随机分为治疗组、对照组,各24例。两组均使用胰岛素降糖、调脂等治疗,并进行饮食控制。对照组治疗上使用厄贝沙坦,治疗组在对照组基础上加用黄葵胶囊。观察两组患者治疗前后24 h尿蛋白、血肌酐(Scr)及血脂水平等变化。结果对照组治疗前后血肌酐(Scr)、24 h尿蛋白对比差异有统计学意义(P0.05);治疗组在血肌酐(Scr)、24 h尿蛋白2个指标改善上优于对照组(P0.05)。两组在总胆固醇(TC)、甘油三脂(TG)2个指标上治疗前后差异无统计学意义(P0.05)。结论厄贝沙坦联合黄葵胶囊治疗2型糖尿病肾病能降低尿蛋白,有效保护肾功能,值得临床推广使用。     

1，25-二羟维生素D3治疗糖尿病肾病疗效观察

目的:探讨1,25-二羟维生素D_3治疗糖尿病肾病(DN)的疗效。方法:将60例DN患者随机分为试验组和对照组,每组30例。2组患者均接受常规降糖治疗,对照组患者口服厄贝沙坦150～300 mg/d;试验组患者口服厄贝沙坦150～300 mg/d,联合口服阿法骨化醇0.25μg,1次/d。记录并比较2组患者治疗前、后血糖化血红蛋白、肌酐等水平。结果:治疗3个月后试验组肌酐、尿N-乙酰-β-氨基葡萄糖苷酶、尿蛋白、血转化生长因子β_1均显著低于对照组(均P0.05)。结论:1,25-二羟维生素D_3对DN患者有肾保护作用。     

大剂量厄贝沙坦治疗慢性肾脏病患者临床蛋白尿的疗效及安全性

目的 评估大剂量厄贝沙坦治疗慢性肾脏病(CKD)患者轻、中度蛋白尿的疗效与安全性.方法 采用单中心前瞻观察性研究,将96例受试者先行厄贝沙坦150 mg/d治疗4周,疗效达好转标准者作为厄贝沙坦单倍剂量组( 150 mg/d)(26例);若单倍剂量治疗无效,逐渐加大厄贝沙坦治疗剂量作为大剂量组( 300～ 600 mg...     

Effect of irbesartan in proteinuric non-diabetic renal disease

This randomized, prospective, two-arm clinical study evaluated the antiproteinuric and nephroprotective effects and the safety of treatment with an angiotensin II receptor antagonist (irbesartan) in patients with chronic glomerulonephritis (CGN) as compared to angiotensin-converting enzyme inhibitors (ACEIls). A total of 50 patients with CGN diagnosed by renal biopsy and protein levels in 24-hour urine higher than 1 g were enrolled. All patients received treatment for at least 24 months, 27 in group 1 (irbesartan) and 23 in group 2 (ACEs). A significant decrease in proteinuria (p < 0.001) was seen in both groups (49.2% in group, 1, and 44.8% in group 2) since the third month, and confirmed at 12 and 24 months of follow-up (58.1% and 62.7% in group 1, and 56.8% and 55.4% in group 2, respectively), with no significant differences being seen between the two groups. No differences were found in blood pressure control. No significant decrease was found in any of the groups in the glomerular filtration rate, but this showed higher values in the group treated with ACEIs (2.98 +/- 7.77 vs 1.64 +/- 6.84 ml/min/year), though the difference with irbersartan was not statistically significant. No side effects occurred among patients treated with irbesartan, whereas three patients initially treated with ACEIs showed intolerance (cough). In conclusion, irbesartan showed in our study an antiproteinuric and nephroprotective effect similar to ACEIs in patients with chronic glomerulonephritis, and its administration was also shown to be safe.     

伴有血脂异常的老年慢性肾小球肾炎CKD1-2期患者临床及病理分析

目的探讨伴有血脂异常的老年慢性肾小球肾炎CKD1-2期患者临床及病理特点,以评估血脂异常对慢性肾脏病的影响。方法纳入2014年至2017年首次行肾活检诊断并符合CKD1-2期原发性慢性肾小球肾炎的老年患者111例,根据有无高脂血症分为高脂血症组(HL组,76例)和非高脂血症组(非HL组,35例),回顾分析两组患者的一般资料、临床及病理特点。结果(1)两组患者年龄、性别比、体质指数、高血压患病率、病理分布类型、血肌酐、高敏C反应蛋白等差异无统计学意义。HL组的血尿酸水平、24 h尿蛋白定量、尿转铁蛋白、尿白蛋白、尿α1微球蛋白、尿NAG酶均高于非HL组,血清白蛋白低于非HL组(P<0.05);(2)HL组血管损伤评分高于非HL组(P<0.05),而肾小球硬化比例、新月体比例、系膜增生、肾小管损伤等评分两组差异无统计学意义;(3)通过二元变量相关分析,24 h尿蛋白、尿转铁蛋白与血清胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白相关,血尿酸、尿白蛋白与与血清胆固醇、甘油三酯、低密度脂蛋白相关,血清白蛋白、尿NAG酶与血清胆固醇、甘油三酯、低密度脂蛋白相关。结论伴血脂异常的老年慢性肾小球肾炎CKD1-2期患者尿蛋白、肾小管损伤更重,肾微血管病变程度更高。     

Glomerulonephritis caused by chronic hepatitis B virus infection: treatment with recombinant human alpha-interferon

STUDY OBJECTIVES: To assess the efficacy of alpha-interferon therapy in patients with hepatitis B virus (HBV)-related glomerulonephritis. DESIGN: Prospective, nonrandomized study. PATIENTS: Five patients with persistence of hepatitis B surface antigen, hepatitis B e antigen (HBeAg) and HBV DNA in serum for at least 6 months and histologic changes of chronic hepatitis on liver biopsy as well as persistent proteinuria of greater than 2 g/d and histologic changes of glomerulonephritis on renal biopsy. INTERVENTIONS: Patients received a 4-month course of recombinant human alpha-interferon (alfa-2b) beginning at a dose of 5 million units administered subcutaneously each day. RESULTS: Serum levels of HBV DNA decreased in all patients and fell to undetectable levels during treatment in four of five patients. In the four responding patients, serum HBeAg disappeared, aminotransferases fell into the normal range, and a follow-up liver biopsy showed an improvement in the hepatocyte necrosis and inflammation. Urine protein excretion also decreased during treatment. In the four responding patients, urine protein excretion gradually fell to less than 1 g/d and serum albumin levels rose into the normal range. Resolution of the biochemical and serologic evidence of chronic hepatitis and glomerulonephritis was accompanied by disappearance of signs and symptoms of liver and kidney disease. CONCLUSIONS: A high proportion of patients with HBV-related glomerulonephritis will respond to a 4-month course of alpha-interferon with a clinical, biochemical, and serologic remission.     

伊贝沙坦与贝那普利治疗老年慢性心力衰竭疗效的比较

目的　比较伊贝沙坦与贝那普利治疗老年慢性心力衰竭 (CHF)的临床疗效及安全性。方法　 6 2例老年CHF患者在常规治疗基础上随机分为两组。伊贝沙坦组 (31例 )用伊贝沙坦 30 0mg d ;贝那普利组 (31例 )用贝那普利 2 0mg d。疗程为 2 0周。结果　伊贝沙坦组治疗后临床显效率 4 1.94 % ,有效率 5 4 .84 % ,无效率 3.2 2 % ;贝那普利组分别为 4 0 .0 0 %、5 6 .6 7%、3.33%。与治疗前比较 ,两组在左心室质量指数、左心室射血分数、左心室舒张末期内径、左心室收缩末期内径等相关参数均有显著改善 ;血压有所下降 ,血钾略有升高 ,但均在正常范围内 ,血肌酐无明显变化 ;两组各有 1例因心力衰竭恶化而再次住院 ,无 1例死亡 ,存活率 10 0 % ;除刺激性干咳、首剂低血压反应发生率伊贝沙坦组明显低于贝那普利组外 ,组间比较差异均无显著性意义。结论　伊贝沙坦治疗老年CHF与贝那普利疗效相似 ,且耐受性、安全性更高 ,对老年CHF患者更有益。可作为老年CHF患者不能耐受血管紧张素转换酶抑制剂的优先选择。     

The calcimimetic cinacalcet normalizes serum calcium in subjects with primary hyperparathyroidism

Calcimimetics increase the sensitivity of the calcium-sensing receptor (CaR) to circulating serum calcium, reducing the secretion of PTH and the serum calcium concentration. We evaluated the calcimimetic cinacalcet, a novel therapy for the management of primary hyperparathyroidism. In this randomized, double-blind, dose-finding study, patients (n = 22) with primary hyperparathyroidism were given cinacalcet (30, 40, or 50 mg) or placebo twice daily for 15 d and observed for an additional 7 d. Serum calcium, plasma PTH, and 24-h and fasting urine calcium were measured. Baseline mean serum calcium was 10.6 mg/dl for the combined cinacalcet-treated patients (normal range, 8.4-10.3 mg/dl), compared with 10.4 mg/dl for the placebo group. Mean PTH at baseline was 102 pg/ml (normal range, 10-65 pg/ml) for the combined cinacalcet-treated patients, compared with 100 pg/ml in the placebo group. Serum calcium normalized after the second dose on d 1 and remained normal through d 15 in all cinacalcet dose groups. Maximum decreases in PTH of over 50% occurred 2-4 h after dosing in all cinacalcet-treated groups. The fasting and 24-h urine calcium to creatinine ratios were similar in the cinacalcet and placebo groups. This study demonstrates that cinacalcet safely normalized serum calcium and lowered PTH concentrations without increasing urinary calcium excretion in the study subjects, indicating the potential benefit of cinacalcet as a medical treatment for primary hyperparathyroidism.     

Pharmacokinetic evaluation of three different intramuscular doses of nandrolone decanoate: analysis of serum and urine samples in healthy men

The pharmacokinetics of nandrolone in serum and urine were investigated in healthy young men after a single im injection of 50 mg (n = 20), 100 mg (n = 17), or 150 mg (n = 17) nandrolone decanoate. Blood samples were collected before treatment and for up to 32 d after dosing. In addition, in the 50- and 150-mg groups, 24-h urine samples were collected before treatment and on d 1, 7, and 33 after treatment; in the 150-mg group, additional samples were collected after 3 and 6 months. Serum concentrations and the area under the curve of nandrolone increased proportionally with the dose administered. The peak serum concentration ranged from 2.14 ng/ml in the 50-mg group to 4.26 ng/ml in the 100-mg group and 5.16 ng/ml in the 150-mg group. The peak serum concentration was reached after 30 h (50 and 100 mg) and 72 h (150 mg), whereas the terminal half-life was 7-12 d. In urine, pretreatment concentrations of 19-norandrosterone (19-NA) and/or 19-noretiocholanolone (19-NE) were detected in five of 37 subjects (14%). In the 50-mg group, 19-NA and/or 19-NE could be detected at least until 33 d after injection in 16 of 17 subjects (94%). In the 150-mg group, who were presumed to have not previously used nandrolone, nandrolone metabolites could be detected for up to 6 months in eight of 12 subjects (67%) for 19-NE and in 10 of 12 subjects (83%) for 19-NA.     

缬沙坦联合氟伐他汀治疗肾性高血压的临床观察

目的:观察缬沙坦与氟伐他汀联合应用对慢性肾病继发性高血压的治疗作用。方法:58例肾性高血压患者被随机分成两组,每组29例:在慢性肾病常规治疗基础上,缬沙坦对照组给予缬沙坦80mg1次/d口服,联合用药组在缬沙坦对照组的基础上加用氟伐他汀40mg1次/d口服,疗程8周。观察治疗前后血压、血肌酐(Scr)、尿素氮(BUN)、24h尿蛋白定量以及血脂的变化。结果:治疗后两组血压、Scr、BUN、24h尿蛋白均显著下降(P0.01),肾功能明显改善,联合用药组Scr[(286.37±84.72):(327.52±92.63)μmol/L]、BUN[(8.35±5.24):(9.46±6.14)mmol/L]、24h尿蛋白[(0.89±0.71):(1.52±0.84)g/L]、血脂均较缬沙坦对照组显著下降(P均0.05)结论:缬沙坦与氟伐他汀联合应用能有效减轻肾病高血压患者的肾脏损害,其疗效优于单用缬沙坦治疗。     

原发性肾小球肾炎患者尿蛋白定量与血清内脂素、同型半胱氨酸的关系

目的:探讨原发性肾小球肾炎(PGN)患者尿蛋白定量与血清内脂素(VF)、同型半胱氨酸(HCY)的关系。方法:选取100例PGN患者作为PGN组,依据治疗结果分为有效组(75例)和无效组(25例),同期选取门诊健康人员30例作为健康组,采用酶联免疫吸附法检测3组血清VF及HCY水平,检测24 h尿蛋白定量,分析24 h尿蛋白定量与血清VF、HCY水平的关系。结果:PGN组24 h尿蛋白定量、血清VF、HCY水平明显高于健康组,且有效组明显低于无效组(均P0.05)。Pearson相关性分析显示,24 h尿蛋白定量与血清VF、HCY水平呈正相关(r_1=0.687,r_2=0.695,均P0.05)。结论:血清VF、HCY水平可能与PGN的发生及其预后转归有关,可作为评估患者病情及预后的重要指标。     

N‐Acetylcysteine in Preventing Contrast‐Induced Nephropathy Assessed by Cystatin C

Aims: Prophylactic oral N‐acetylcysteine (NAC) has been widely used for prevention of contrast‐induced nephropathy (CIN). However, clinical studies have not been demonstrating this effect consistently because of evidence that NAC can alter serum creatinine levels without affecting glomerular filtration rate (GFR). We investigated NAC for the prevention of CIN by monitoring creatinine and cystatin C. Methods: We enrolled 113 patients (49 patients in NAC group and 64 patients in control group) with normal to subnormal GFR who were scheduled for cardiovascular procedures. Patients in NAC group receive acetylcysteine 600 mg twice a day, on the day before and on the day of cardiovascular procedure. All patients received a periprocedural intravenous infusion ("volume expansion") of 1 ml/kg/h with 0.45% saline for 24 h (12 h before and 12 h after exposure to contrast medium). Serum cystatin C and creatinine levels were measured before and at 12, 24, and 48 h after procedure. Results: The incidence of cystatin C‐based CIN was 28.5% (n = 14) in NAC and 23.4% (n = 15) in control group (p = 0.663) and serum creatinine‐based CIN was 12.2% (n = 6) in NAC and 17.2% (n = 11) in control group (P= 0.468). In this study, oral NAC had no effect on the prevention of CIN in patients undergoing cardiovascular procedures. Conclusion: In this study, oral NAC administration does not reduce neither the incidence of cystatin C‐based CIN nor serum creatinine‐based CIN in patients undergoing cardiovascular procedures.