缬沙坦联合叶酸对老年高血压肾病患者降压及降同型半胱氨酸的临床研究

目的探讨老年高血压肾病患者血浆同型半胱氨酸、血清叶酸及维生素B12的浓度,同时加用缬沙坦联合叶酸,观察其对老年高血压肾病患者降压及降低高同型半胱氨酸血症(Hhcy),及对肾功能的保护作用。方法选2009年10月至2011年5月我院住院及门诊患者共75例原发性高血压伴蛋白尿或轻中度肾功能衰竭(eGFR 30～60 ml/min)患者。随机分为两组。对照组给予缬沙坦80 mg/d、观察组缬沙坦80 mg+叶酸0.8 mg/d,连续治疗8周。监测血压。测定给药前、给药后第4周和第8周3个不同时点的血浆同型半胱氨酸(Hcy)水平和尿白蛋白排泄率(UAE)、血清半胱氨酸蛋白酶抑制剂C(CysC)、血清叶酸、维生素B12的浓度,计算eGFR。结果两组治疗2、4、6、8周,收缩压(SBP)和舒张压(DBP)均有下降趋势,组间、不同时点、组间和不同时点的交互作用比较差异有统计学意义(均P<0.01)。两组患者均存在Hcy水平增高、叶酸水平降低、维生素B12水平降低。治疗8周后,观察组血浆Hcy、尿白蛋白排泄率(UAE)、血清叶酸、维生素B12、血清半胱氨酸蛋白酶抑制剂C(Cys C)、eGFR改善较对照组差异明显(均P<0.01),分别为(10.43±4.16)μmol/L vs(15.75±9.20)μmol/L,(110.93±56.32)μg/min vs(215.75±79.28)μg/min,(14.7±5.5)nmol/L vs(8.59±1.66)nmol/L,(784.56±111.49)nmol/L vs(421.52±167.75)nmol/L,(1.72±2.41)mg/L vs(3.47±1.99)mg/L,(74.53±21.33)ml/min vs(61.02±27.43)ml/min(P<0.01)。结论缬沙坦联合叶酸治疗老年高血压合并早中期肾损害患者,对于有效降压、延缓甚至阻止肾功能损伤和恶化意义重大。

The effect of Valsartan-Folic Acid Combination in patients with mild-to-moderate degree essential hypertensive renal disease

Objective To access the effect of Valsartan-Folic Combination versus Valsartan in patients witll mild-to-moderate degree essential hypeaensive renal disease.Methods A randomized double-blind arm clinical study enrolled 75 patients,who randomly receive either valsartan(80 mg)once or valsartan(80 mg) combined with folic acid(0.8 mg)once daily for 8weeks after a week wash out period.Blood pressure,Hcy,UAE,folic acid,vitB12 and eGFR were measured aftereight weeks of treatment.Results Treatment of 2 weeks,4 weeks,6 weeks and 8 weeks,systolic blood pressure and diastolic blood pressure in both groups had a downward trend(P<0.01).The two drugs combined decreased in Hcy,UAE and increasde in folic acid,vitB12 and eGFR in observer group even more obviously than those of control group,respectively,(10.43±4.16) μmol/L vs(15.75±9.20) μmol/L,(110.93±56.32) μg/min vs(215.75±79.28) μg/min,(14.7±5.5)nmol/L vs(8.59±1.66)nmol/L,(784.56±111.49)nmol/L vs(421.52±167.75)nmol/L,(1.72±2.41) mg/L vs(3.47±1.99) mg/L,(74.53±21.33)ml/min vs(61.02±27.43)ml/min(P<0.01).Conclusion Therapeutic effect of valsartan combined with folic acid on old hypertensive patients with mild-to-moderate degree kidney damage is better than that of simply use of valsartan in old people.