氯沙坦治疗肾移植术后的高血压和高尿酸血症

目的 探讨氯沙坦治疗肾移植术后高尿酸血症和高血压的有效性和安全性。方法 以环孢素A（CsA）为基础免疫抑制治疗的肾移植患者36例，术后应用氯沙坦或卡托普利，共4周；经过7d洗脱期后，将氯沙坦和卡托普利相互替换治疗患者，共4周。采用双因素随机交叉试验设计，测定血尿酸、尿尿酸、血肌酐、尿肌酐、24h尿蛋白定量、血钾、血红蛋白、血CsA浓度及血压的基础值和药物治疗4周后的改变值。结果 氯沙坦治疗后，36例患者血尿酸较基础值明显下降，差异有统计学意义（P〈0．01），尿尿酸较基础值明显增加（P〈0．05），而卡托普利治疗后，血尿酸及尿尿酸均无明显改变。经过氯沙坦和卡托普利治疗4周后，患者的收缩压和舒张压较基础值均有明显下降，且均达到目标值范围，差异有统计学意义（P〈0．01）。经氯沙坦和卡托普利治疗后，患者的血红蛋白较基础值均明显下降（P〈0．05），血清CsA浓度较基础值均降低（P〈0．05），但CsA浓度仍在目标值范围。结论 氯沙坦不仅可有效控制肾移植术后的高血压，而且可以明显减轻高尿酸血症。

Effect of losartan in the treatment of hyperuricemia and hypertension in patients with renal transplantation

Objective To evaluate the efficacy and safety of Losartan in the treatment of hyperuricemia and hypertension following renal transplantation.Methods Thirty-six patients after renal transplantation treated with cyclosporin A(CsA) were studied in an open randomized crossover trial and were administered with either Losartan or Capton.Laboratory parameters as serum uric acid,serum creatinine,serum potassium,hemoglobin,24-h urinary uric acid,24-h urinary creatinine,24-hurinary protein,serum CsA concentration,cyclosporin trough level,and blood pressure were checked before and 4 weeks after treatment of Losartan or Capton.Results Compared with Capton group,serum uric acid concentrations in Losartan group were significantly decreased,and 24-h urinary uric acid significantly increased.Systolic or diastolic pressure and CsA concentration in Losartan group orCapton group were significantly decreased as compared with baseline,but there was no significant difference between Losartan group and Capton group.Serum creatinine remained stable in all patients,and no patients changed the CsA dosage.24-h urinary protein excretion in Losartan group was significantly decreased.Serum potassium levels were significantly increased during Capton therapy,but Losartan only had a mildly effect on it.Hemoglobin in Losartan group or Capton group was significantly decreased,but there was no significant difference between them(P>(0.05)).Conclusions Losartan can only effectively hypertension following renal transplantation,but also obviously lessen slight hyperuricemia.