氨氯地平联合依那普利降压对老年高血压伴冠心病患者肾功能的保护作用

摘要

目的:研究氨氯地平联合依那普利降压对老年高血压伴冠心病患者肾功能的影响.方法:纳入2014年2月至2016年8月我院120例老年高血压伴冠心病患者.患者被随机均分为氨氯地平组、依那普利组和联合治疗组(接受氨氯地平联合依那普利治疗),疗程均为12周.测量比较三组总有效率、血压达标情况、治疗前后尿白蛋白排泄率(UAER)、血肌酐(Scr)、血清胱抑素C (CysC)和尿素氮(BUN)水平以及不良反应发生情况.结果:三组的总有效率无显著差异,P＝ 0.139.与氨氯地平组和依那普利组比较,联合治疗组血压达标时间显著缩短[(10.84 ± 2.79)月比(10.75 ± 3.31)月比(8.20 ± 1.46)月,P均＝0.001].与治疗前比较,治疗12周后氨氯地平组和联合治疗组 UAER 、 Scr 、血清 CysC和 BUN水平均显著下降(P＜ 0.05或＜ 0.01);治疗12周后,与氨氯地平组、依那普利组比较,联合治疗组 UAER [ (130.55 ± 12.72) μg/min比(135.63 ± 17.64) μg/min比(112.25 ± 13.34) μg/min]、 Scr [ (79.32 ± 6.13) μmol/L比(80.25 ± 5.97) μmol/L比(68.04 ± 5.56) μmol/L]、血清CysC [ (1.14 ± 0.23) mg/L比(1.21 ± 0.26) mg/L比(0.76 ± 0.17) mg/L]及BUN [ (5.16 ± 1.13) mmol/L比(5.79 ± 1.03) mmol/L比(4.23 ± 0.56) mmol/L]水平均显著降低,氨氯地平组BUN水平显著低于依那普利组,P＜0.05或＜0.01.三组治疗期间不良反应发生率无显著差异,P＝0.757.结论:小剂量氨氯地平联合依那普利治疗老年高血压伴冠心病患者,血压控制满意,对肾功能保护作用优于单一用药方案,且安全性高,值得推广.%Objective:To study influence of amlodipine combined enalapril antihypertensive therapy on renal function in aged patients with essential hypertension (EH) complicated coronary heart disease (CHD).Methods:A total of 120 aged EH + CHD patients in our hospital from Feb 2014 to Apr 2016 were enrolled.Patients were randomly and equally divided into amlodipine group,enalapril group and combined treatment group (received amlodipine com-bined enalapril treatment ),all groups were treated for 12 weeks.Total effective rate,standard-reaching condition of blood pressure,urinary albumin excretion rate (UAER),levels of serum creatinine (Scr),cystatin C (CysC) and blood urea nitrogen (BUN) before and after treatment,and incidence of adverse reactions were measured and com-pared among three groups.Results:There was no significant difference in total effective rate among three groups,P＝0.139.Compared with amlodipine group and enalapril group,there was significant reduction in standard-reaching time of blood pressure [ (10.84 ± 2.79) months vs.(10.75 ± 3.31) months vs.(8.20 ± 1.46) months] in com-bined treatment group,P＝0.001 all.Compared with before treatment,after 12-week treatment,there were sig-nificant reductions in UAER,levels of Scr,serum CysC and BUN in amlodipine group and combined treatment group,P＜0.05 or ＜ 0.01;compared with amlodipine group and enalapril group after 12-week treatment,there were significant reductions in UAER [(130.55 ± 12.72) μg/min vs.(135.63 ± 17.64) μg/min vs.(112.25 ± 13.34) μg/min],levels of Scr [ (79.32 ± 6.13) μmol/L vs.(80.25 ± 5.97) μmol/L vs.(68.04 ± 5.56) μmol/L],serum CysC [ (1.14 ± 0.23) mg/L vs.(1.21 ± 0.26) mg/L vs.(0.76 ± 0.17) mg/L] and BUN [ (5.16 ± 1.13) mmol/L vs.(5.79 ± 1.03) mmol/L vs.(4.23 ± 0.56) mmol/L] in combined treatment group,and BUN level of amlodip-ine group was significantly lower than that of enalapril group,P＜0.05 or ＜0.01.There was no significant differ-ence in incidence rate of adverse reactions during treatment among three groups,P＝0.757.Conclusion:Small dose amlodipine combined enalapril is effective on controlling blood pressure in aged EH + CHD patients.Compared with monotherapy,it possesses better protection on renal function with high safety,which is worth extending.