摘要
目的采用多普勒肾血流测定观察治疗前后肾血流的变化,探讨不同降压药物是否具有肾脏保护作用及其作用机制。方法回顾性分析了接受不同降压药物治疗的高血压患者52例。根据服用药物的种类分为3组血管紧张素转换酶抑制剂(ACEI)组、钙通道阻滞剂(CCB)组和ACEI+CCB组。采用超声多普勒肾血流测定,结合放免法测定血、尿β2-微球蛋白,观察服用不同降压药物前后肾功能的变化。结果ACEI类药物主要改善收缩期最大血流速度(Vs)和脉冲指数(PI)、阻力指数(RI)(P均<0.01);CCB类药物主要改善血流峰速加速时间(AT)和血流峰速加速度(AC)(P均<0.01)。ACEI对肾内大血管(段动脉,P<0.01)的影响大于对小血管(叶间动脉,P<0.05)的影响。联合用药组各项血流参数的改善程度较单独应用ACEI或CCB中的任一类药物都大。结论ACEI和CCB类药物在肾脏保护作用上各有优势,而且联合应用这两类药物比单独应用任一类能更好的延缓高血压肾损害的进展。
Objective To investigate the renal protective effects and their mechanisms of different antihypertensive drugs. Methods Fifty-two patients with essential hypertension included in this study were divided into three groups according to different antihypertensive drugs including angiotensin-converting-enzyme inhibitor （ACEI）, calcium channel blocker（ CCB）, combination of ACEI and CCB. Renal functions were examined with biochemical tests and ultrasound Doppler renal hemodynamics before and after treatment. Results SBP and DBP of all patients were decreased significantly（P 〈0.01）. Except for β2-MG（ P 〈 0. 05）, there were no significant changes in BUN, SCr and CCr, The renal blood flow was increased（ P 〈 0.01 ） and the vascular resistance was decreased （ P 〈 0.01 ） in the patients taking ACEI, The acceleration time was shortened（ P 〈 0.01 ） and acceleration was increased（ P 〈 0.01 ） in CCB group. In ACEI ＋ CCB group, the renal blood flow was increased and the resistance was decreased significantly after treatment. AT was shortened, and AC was increased. Conclusions Ultrasound Doppler renal blood flow measurement is one useful method in evalua- ting the renal protective effects of antihypertensive drugs because it can sensitively reflect the changes of the renal hemodynamics. ACEI and CCB both have their own advantages in renoprotective properties. Moreover, the renoprotective function of combination administration of ACEI and CCB is obviously stronger than any drug used alone.
出处
《实用老年医学》
CAS
2006年第6期376-379,共4页
Practical Geriatrics
关键词
高血压
肾
血管紧张素转换酶抑制药
钙通道阻滞药
肾循环
Hypertension
Kidney
Angiotensin-converting enzyme inhibitors
Calcium channel blockers
Renal circulation
