贝那普利治疗肾移植术后红细胞增多症的疗效观察

目的  观察贝那普利治疗肾移植术后红细胞增多症(PTE)的疗效及不良反应。方法  选择2012年6月至2013年6月在解放军第309医院泌尿外科行首次肾移植术, 术后继发PTE的22例患者为研究对象, 根据有否高血压分为高血压组(14例)和正常血压组(8例)。高血压组给予贝那普利, 起始剂量为10 mg/d, 以后视病情变化最大剂量可增至40 mg/d; 正常血压组给予贝那普利5 mg/d, 血红蛋白及红细胞压积恢复正常后予以维持剂量2.5 mg/d。随访6个月比较两组患者服药后治疗效果和随访期间的不良反应。结果  治疗6个月后, 高血压组显效12例、有效1例、进步1例; 正常血压组显效6例、有效1例、无效1例。两组疗效比较, 差异无统计学意义(P > 0.05)。治疗过程中高血压组患者血压明显下降(P < 0.05), 正常血压组患者血压未见明显变化。治疗前后两组患者的红细胞、中性粒细胞、血小板、血清肌酐、尿酸、估计肾小球滤过率等指标未见明显异常。高血压组中1例患者治疗期间出现刺激性咳嗽, 停药后恢复正常。结论  肾移植术后PTE患者服用贝那普利治疗是安全有效的。应根据患者的血压从小剂量开始给药, 治疗过程中监测血压、血常规和肾功能, 根据血压调整药物剂量。

Observation of curative effect of benazepril on polycythemia after kidney transplantation

Objective To observe the curative effect and adverse reaction of benazepril on polycythemia (PTE) after renal transplantation. Methods Twenty-two patients undergoing kidney transplantation for the first time at the Department of Urinary Surgery of the 309th Hospital of People's Liberation Army and developed PTE after renal transplantation from June 2012 to June 2013 were enrolled as the object of study. The patients were divided into the hypertension group (n=14) and the normal blood pressure group (n=8) according to whether the patients were with hypertension or not. The hypertension group was given benazepril with an initial dose of 10 mg/d and increased to the maximum dose of 40 mg/d according to the changes of patients' conditions. The normal blood pressure group was given benazepril with an initial dose of 5 mg/d and with the maintenance dose of 2.5 mg/d after hemoglobin and hematokrit returning to normal. The patients in two groups were followed up for 6 months. The curative effect and adverse reactions during the follow-up were compared between the two groups. Results After 6 months of treatment, 12 patients had marked effect, 1 had effect and 1 was improved in the hypertension group. Six patients had marked effect, 1 had effect and 1 had no effect in the normal blood pressure group. The difference of efficacy had no statistical significance between the two groups (P > 0.05). During the treatment, the blood pressure of the hypertension group dropped significantly (P < 0.05), while that of the normal blood pressure group had no significant change. Red blood cells, neutrophils, platelets, serum creatinine, uric acid and estimated glomerular filtration rate of the two groups had no obvious abnormality before and after treatment. One patient in the hypertension group developed irritable cough during the treatment and recovered after withdrawal. Conclusions It is safe and effective to take benazepril for patients with PTE after renal transplantation. It is recommended to start with small dose and the dose shall be adjusted according to blood pressure. The blood pressure, blood routine and renal function shall be monitored during the treatment.