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位置: 主页 > 代写硕士论文 > 血管紧张素Ⅱ受体拮抗剂与血管紧张素转化酶抑制剂干预轻中度高血压患者尿酸代谢的对比研究

血管紧张素Ⅱ受体拮抗剂与血管紧张素转化酶抑制剂干预轻中度高血压患者尿酸代谢的对比研究

时间:2017-08-29 14:00:04 来源: 代写硕士论文

【关键词】  高血压;高尿酸血症;血管紧张素Ⅱ受体拮抗剂;ACEI


    Angiotensin II receptor antagonist and angiotensin converting enzyme inhibitors interfere with mild to moderate hypertensive patients comparative study of uric acid metabolism

       【Abstract】  Objective  To investigate the angiotensin II receptor antagonist (ARB) losartan and angiotensin converting enzyme inhibitors (ACEI) enalapril with the treatment of the hyperuricemia in patients with essential hypertension levels of serum uric acid, and evaluation of its efficacy.Methods  A random,double-blind. parallel. control design,198 cases of 1 to 2 grade patients with essential hypertension (with hyperuricemia: male serum uric acid concentrations> 400μmol / L,female> 320μmol / L. BUN,SCR which in the normal range) by two weeks placebo after elution,random divided into losartan group or enalapril group, treatment four weeks. if the blood pressure under control [systolic blood pressure <140 mmHg and (or) diastolic blood pressure <90 mmHg],continue to the original dose treatment four weeks, if blood pressure was not controlled [systolic blood pressure> 140 mmHg and (or) diastolic blood pressure> 90 mmHg] will be above drug dose doubled to four weeks treatment, observation of serum uric acid concentration and blood pressure changes.Results  Losartan randomly selected group 100 cases,enalapril group 98 cases, and treatment earlier, losartan group of four weekends, 8 weekend serum uric acid concentration decreased significantly (P<0. 001), enalapril group had no significant (P>0.05); Comparison between the two groups: the treatment four weeks .8 weeks serum uric acid concentrations of losartan group was lower than enalapril group (P<0.001).Before treatment: two groups of four weeks. eight weeks systolic and diastolic blood pressure were significantly reduced (P<0.0001). Comparison between the two groups of four weeks,8 weekend systolic and diastolic blood pressure difference was not statistically significant (P>0.05).Conclusion  Losartan treatment can significantly reduce associated with high blood uric acid patients with essential hypertension of the blood uric acid level. Enalapril lowering serum uric acid had no significant effect,two drugs can effectively control blood pressure. Therefore, treatment with losartan is hyperuricemia in patients with mild to moderate hypertension ideal choice.

    【Key words】  hypertension;hyperuricemia;angiotensin II receptor antagonist;ACEI

    近年来血管紧张素Ⅱ受体拮抗剂(ARB)及ACEI在临床上得到越来越广泛的应用,高尿酸血症是原发性高血压患者常见代谢紊乱现象,高尿酸血症可能是心血管疾病的一个独立危险因子[1,2],因此降低血尿酸治疗对于高血压伴高尿酸血症的患者具有潜在的重要临床意义。

  1  资料与方法

    1.1  一般资料  入选对象为1~2级原发性高血压(卧位DBP 90~109mmHg,且卧位SBP 140~179mmHg,同时伴高尿酸血症:男≥400μmol/L,女≥320μmol/L)[3],年龄>18岁,排除各类继发性高血压、近期有痛风发作者、近2月内有急性心力衰竭、脑卒中、TIA、AMI、严重心律失常,肝肾功能障碍(ALT≥2倍正常值,SCR≥176.8μmol/L),必须服用利尿剂等影响嘌呤代谢药物及其他降压药物的患者,孕妇、哺乳期的妇女、精神病、糖尿病(血糖未得到很好的控制)患者,参加研究的患者签署书面知情同意书。

    1.2  研究设计  采用随机、双盲、平行对照设计,经过2周筛选洗脱安慰剂导入后,合格的患者随机接受氯沙坦片(商品名:科素亚,杭州默沙东制药有限公司生产)50mg或依那普利片10mg治疗,每2周随访1次,第4周末若血压未达目标值(SBP≤140mmHg,DBP≤90mmHg),则药物剂量加倍。

    1.3  临床观察项目和指标  包括症状、体征及采取空腹周围静脉血测定血尿酸、ALT、AST、BS、BUN、SCR、血脂、电解质,血尿酸在治疗前、治疗4周及8周末各测1次,其他检测项目在治疗前、8周末各测1次,抽血测定要求前2日素食。

    1.4  统计学分析  所有资料输入计算机,建立数据库,采用SPSS统计软件进行统计学处理,计量资料用均数±标准差表示,采用t检验,计数资料采用卡方检验,以P<0.05为差异有显著性。

  2  结果

    2.1  两组基础情况  对试验者进行统计分析,两组基本情况相匹配。见表1。表1  两组基本情况

    2.2  治疗后两组血清尿酸变化  研究结果提示,氯沙坦50mg口服,qd,治疗4周,血尿酸从440.23μmol/L降至368.35μmol/L(P<0.01);氯沙坦50mg或100mg口服,qd,治疗8周,血尿酸从440.23μmol/L降至358.2μmol/L(P<0.001);依那普利组血尿酸虽有降低,但与治疗前相比差异无显著性。治疗4周和8周后,两组相比血尿酸浓度差异有显著性。见表2表2  两组治疗4周、8周后血尿酸水平 注:氯沙坦组治疗前比较,P<0.001;与依那普利组同期比较,P<0.001

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