氯沙坦对高血压病患者尿白蛋白及纤溶活性的影响

目的　探讨尿白蛋白排泄率与纤溶活性的关系及氯沙坦对其影响。方法　选择 6 2例高血压病伴轻、中度肾功能损害 (肌酐清除率 <70mL/min ,但≥ 30mL/min)患者 ,经随机分为两组分别予氯沙坦 5 0～ 10 0mg/d或卡托普利75～ 15 0mg/d降压治疗 12周。同时选择 2 4例高血压病伴肾功能完全正常 (肌酐清除率≥ 80mL/min)患者作为对照组 ,降压治疗前后分别测定尿白蛋白排泄率 (UAE)、纤溶酶原激活剂活性 (tPA)、纤溶酶原激活抑制剂活性 (PAI)。结果　肾功能异常组UAE、PAI均升高 (P <0 0 1) ,tPA降低 (P <0 0 5 ) ;UAE与tPA ,PAI,PAI/tPA相关系数分别为 0 2 0 (P >0 1)、0 32 (P <0 0 5 )、0 34(P <0 0 1) ,UAE与纤溶活性降低正相关 ;降压治疗后两组均降低UAE、PAI(P <0 0 1) ,卡托普利组还升高tPA(P <0 0 5 )。结论　肾功能异常时纤溶活性降低 ,肾功能损害与纤溶降低有关 ,氯沙坦及卡托普利改善肾功能 ,也改善纤溶活性。

The Effects of Losartan on Urine Albumin Excretion and Plasma Fibrinolytic Activity

Objective To ivestigate the relationship between changes of plasma fibrinolytic activity and urine albumin excretion (UAE) and the effects of Losartan on them. Methods 62 essential hypertensive patients with abnormal renal function were randomly treated with Losartan or Captopril for 12 weeks, tissue typed plasminogen activator activity (tPA), plasminogen activator inhibitor (PAI) were determined with color substrate, UAE was determined with radiolimmunoassay befor treatment and repeated after 12 weeks. Results Abnormal renal function group had significantly higer UAE and PAI activity ( P <0 01), lower tPA activity ( P< 0 05). In addition, UAE was positively related with PAI( r =0 32, P <0 05) and PAI/tPA( r =0 34, P <0 01). UAE and PAI were decreased after treatment of Losartan or Captopril, tPA was increased only in Captopril group. Conclusion Plasma fibrinolytic activity decreased in hypertensive patients with renal impairment, abnormalities of fibrinolytic activity may play an important role in hypertensive renal impairment, both Losartan and Captopril could improve renal function and fibrinolytic activity.