阿托伐他汀对老年高血压肾病患者血流动力学的影响

目的:观察阿托伐他汀对老年高血压肾病患者肾脏血流动力学及肾功能的影响?方法:选择56例老年高血压肾病患者随机给予常规治疗(对照组)及常规+阿托伐他汀治疗(阿托伐他汀组),治疗前和治疗1?6个月时查诊室血压?低密度脂蛋白胆固醇(LDL-C)?丙氨酸氨基转移酶(ALT)?肌酸激酶(CK)?血肌酐?24 h尿蛋白定量,并估算肾小球滤过率(eGFR);治疗前和治疗6个月时采用彩色多普勒超声测定治疗前后肾血流动力学的变化?结果:阿托伐他汀组患者LDL-C水平1个月及6个月时均较治疗前明显降低(P < 0.05),与对照组间差异显著(P < 0.01);24 h尿蛋白定量1个月时无明显变化,6个月时阿托伐他汀组与对照组较治疗前均明显降低(P < 0.05),阿托伐他汀组降低更加明显,两组间差异显著(P < 0.05);血肌酐及eGFR 1个月时无变化,6个月时阿托伐他汀组较治疗前血肌酐有所降低,eGFR有所升高,但差异无显著性(P > 0.05),治疗前后差值与对照组比较,差异显著(P < 0.05);两组治疗前后双侧肾动脉(RA)?段动脉(SRA)?叶间动脉(IRA)的收缩期最大流速(PSV)无显著变化,6个月时治疗组各级动脉舒张末期最低流速(EDV)较治疗前明显升高(P < 0.05),阻力指数(RI)较治疗前明显降低(P < 0.05),治疗前后差值与对照组比较差异显著(P < 0.05),RA的EDV差异特别显著(P < 0.01)?结论:阿托伐他汀对老年高血压肾病患者有肾脏保护作用,降低肾动脉血管阻力,改善肾血管结构,可能是其肾保护机制之一?

The effect of atorvastatin on renal hemodynamics of the elder patients with hypertensive nephropathy

Objective:To observe the effect of atorvastatin on renal function and hemodynamics in elderly hypertensive patients. Methods:Fifty-six elderly hypertensive patients with hypertensive nephropathy were randomly divided into atorvastatin group(n = 29) and control group(n = 27), atorvastatin group was treated with atorvastatin for six months. The variation of blood pressure, low density lipoprotein cholesterol(LDL-C), alanine aminotransferase(ALT), creatine kinase(CK), creatinine, estimated glomerular filtration rate (eGFR), 24-hour urinary protein quantitation were examined, and the renal hemodynamics were observed by colour Doppler ultrasound before and after treatment. Results:LDL-C in atorvastatin group decreased significantly after 1 month or 6 months of treatment(P < 0.05). 24-hour urinary protein quantitation was unchanged in one month, and decreased significantly in 6 months in both groups(P < 0.05), which was lower in atorvastatin group than in control group(P < 0.05). Creatinine and eGFR were unchanged in both groups after 1 month of treatment,while in 6 months,creatinine decreased and eGFR increased in both groups, but no significant difference was achieved (P > 0.05), however, the difference was significant between two groups(P < 0.05). No significant difference was found in the peak systolic velocity (PSV) of bilateral renal artery (RA), segmental renal artery(SRA), leaves renal artery (IRA) in two groups before and after treatment. In the atorvastatin group, end-diastolic minimum flow(EDV) increased and resistance index (RI) of RA, SRA and IRA decreased significantly after 6 months of treatment (P < 0.05), significant difference was found between two groups (P < 0.05), especially for the difference of RA(P < 0.01). Conclusion:Atorvastatin have protective effect on renal in patients with hypertensive nephropathy. Reducing renal arteries resistance, improving renal vascular structure may be one of the renal protective mechanisms.