氟伐他汀和辛伐他汀对高血压肾病尿蛋白的影响及其对比研究

目的观察氟伐他汀和辛伐他汀对血压控制达标的原发性高血压肾病患者尿蛋白的影响及其有效性和安全性的对比。方法纳入90例血压控制达标的原发性高血压肾病患者,随机分为氟伐他汀组（FS组,n=30）、辛伐他汀组（SS组,n=30）或安慰剂对照组（PC组,n=30）,分别给予氟伐他汀（40mg/d）、辛伐他汀（40mg/d）或安慰剂治疗6个月。观察治疗前后收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、血肌酐（SCr）、尿素氮（BUN）、24小时尿蛋白（24hU-Pro）、血清白蛋白（ALB）、肌酸激酶（CK）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）等指标的变化。结果治疗6个月后,FS组和SS组的TC、LDL-C、24hU-Pro均较治疗前显著降低（P〈0.05）,分别为FS组TC（5.26±0.73）mmol/L vs（3.82±0.52）mmol/L;LDL-C（3.84±0.47）mmol/L vs（2.73±0.51）mmol/L;24hU-Pro（1.32±0.32）g vs（0.77±0.21）g（均P〈0.05）;SS组TC（5.37±0.65）mmol/L vs（3.95±0.66）mmol/L;LDL-C（3.69±0.37）mmol/L vs（2.84±0.41）mmol/L;24hU-Pro（1.25±0.43）g vs（0.81±0.27）g（均P〈0.05）.而对照组治疗前后比较TC、LDL-C、24hU-Pro差异均无统计学意义。3组治疗前后的SBP/DBP、TG、HDL-C、SCr、BUN、CK、AST、ALT等指标差异均无统计学意义（P〉0.05）,组间差异也无统计学意义（P〉0.05）。结论氟伐他汀和辛伐他汀均可减少原发性高血压肾病患者的尿蛋白排泄,两者的肾脏保护作用相当,且均具有良好的安全性。

Comparison in effects of fluvastatin and simvastatin on proteinuria of patients with hypertensive nephropathy

Objective To investigate the effects of fluvastatin and simvastatin on proteinuria in hypertensive nephropathy with well-controlled hypertension,and to compare the efficacy and safety between them. Methods 90 patients with hypertensive nephrophathy,whose blood pressure had been well-controlled（140/90 mmHg） over a month,were randomized to receive fluvastatin 40 mg/d（FS group,n=30）,simvastatin 40 mg/d（SS group,n=30） or placebo（PC group,n=30） treatment for 6 months.Blood pressure（SBP/DBP）,serum lipids including total cholesterol（TC）,triglycerides（TG）,low-density lipoprotein cholesterol（LDL-C）,high-density lipoprotein cholesterol（HDL-C）,serum creatinine（SCr）,blood urea nitrogen（BUN）,proteinuria of 24 hours（24 hU-Pro）,serum albumin（ALB）,creatine kinase（CK）,aspartate transaminase（AST）,alanine transaminase（ALT） were measured before and after the study. Results After 6 months of treatment,levels of TC,LDL-C and 24 hU-Pro in FS group and SS group were significantly decreased compared to those in placebo group（P0.05）,FS group TC（5.26±0.73） mmol/L vs（3.82±0.52） mmol/L;LDL-C（3.84±0.47） mmol/L vs（2.73±0.51） mmol/L;24 hU-Pro（1.32±0.32） g vs（0.77±0.21） g（all P0.05）;SS group TC（5.37±0.65） mmol/L vs（3.95±0.66） mmol/L;LDL-C（3.69±0.37） mmol/L vs（2.84±0.41） mmol/L;24 hU-Pro（1.25±0.43） g vs（0.81±0.27） g（all P0.05）,respectively.While the decreasing extent was similar between the two statin groups.Other clinical characteristics such as SBP/DBP,TG,HDL-C,SCr,BUN,CK,AST,ALT in FS group and SS group all had no significant change either after intervention or compared to those in placebo group（P0.05）. Conclusion Both fluvastatin and simvastatin were demonstrated to exert a beneficial effect on reducing proteinuria in patients with hypertensive nephropathy,while their abilities to afford renal protection and therapeutic safety were similar.