血管紧张素Ⅱ受体拮抗剂对腹膜透析患者左心室肥厚的消退作用
投稿时间:2016-04-02  修订日期:2016-05-04  点此下载全文
引用本文:吴秀娟,王时敏,官继超,单娟萍,蒋宗明,沈水娟.血管紧张素Ⅱ受体拮抗剂对腹膜透析患者左心室肥厚的消退作用[J].医学研究杂志,2017,46(1):142-146
DOI: 10.11969/j.issn.1673-548X.2017.01.038
摘要点击次数: 1148
全文下载次数: 788
作者单位E-mail
吴秀娟 312000 绍兴市人民医院(浙江大学绍兴医院)肾内科  
王时敏 312000 绍兴市人民医院(浙江大学绍兴医院)肾内科 jiangzhejiang120@163.com 
官继超 312000 绍兴市人民医院(浙江大学绍兴医院)肾内科  
单娟萍 312000 绍兴市人民医院(浙江大学绍兴医院)肾内科  
蒋宗明 312000 绍兴市人民医院(浙江大学绍兴医院)肾内科  
沈水娟 312000 绍兴市人民医院(浙江大学绍兴医院)肾内科  
中文摘要:目的 观察血管紧张素Ⅱ受体拮抗剂(ARB)对持续性非卧床腹膜透析(CAPD)高血压患者左心室肥厚和动脉硬化指数的影响。方法 65例接受CAPD患者,根据其服用降压药物不同分为ARB(缬沙坦)组(A组)和非血管紧张素转换酶抑制剂/ARB组(B组)两组,两组降压目标均为≤140mmHg/90mmHg,每间隔6个月定期至门诊随访,共随访24个月,即入选时(T0)、6个月(T6)、12个月(T12)、18个月(T18)、24个月(T24)。于随访各时点记录两组患者的血压、血肌酐、脑钠肽、尿量、超滤和肌酐清除率及心脏超声测定左心室舒张末期内径、室间隔厚度、心胸比等,计算左心室质量指数(LVMI)。同时观察T0、T12和T24时动态血压监测,测定血压变异率并通过一系列计算获取动态动脉硬化指数。结果 与基础值T0比较,降压治疗第18个月后两组LVMI均明显下降(P<0.05);与B组相应时点比较,A组T6、T12、T18和T24时点LVMI显著降低(P<0.05)。与各组基础值比较,治疗后心胸比值下降(P<0.05);A组T12、T18和T24时点心胸比和脑钠肽值较B组相应时点降低(P<0.05)。与B组比较,A组T12和T24时间点24h收缩压变异、24h舒张压变异和动脉硬化指数显著降低(P<0.05)。心力衰竭再次住院率A组(5.4%)显著低于B组(11.6%)。结论 ARB能促进其CAPD患者左心室肥厚的消退,降低血压变异和动脉硬化指数,可减少因心力衰竭再次住院发生率。
中文关键词:血管紧张素Ⅱ受体拮抗剂  持续性非卧床腹膜透析  左心室肥厚  动脉硬化指数
 
Angiotensin Receptor Antagonist Produced Amelioration of Left Ventricular Hypertrophy in Continuous Ambulatory Peritoneal Dialysis Patients
Abstract:Objective To study the effects of angiotensin receptor antagonist (ARB) on progression of left ventricular hypertrophy and arterial stiffness index in hypertensive patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods Sixty five patients undergoing CAPD were included and allocated into two groups (ARB group using ARB agents, and non-angiotensin converting enzyme inhibitor/non-ARB group) in accordance with hypertensive drugs intake. The target blood pressure was titrated to below 140mmHg/90mmHg in two groups. Patients were told to visit clinic every six months,and the duration of follow-up period was 24 months. Serum creatinine, brain natriuretic peptide and electrolyte were assayed. Blood pressure,volume of ultra-filtration fluid and endogenous creatinine clearance rate were recorded. Parameters, such as left ventricular end-diastolic diameter, intraseptal thickness,chest thoracic ratio under echocardiography were recorded. Left ventricular mass index (LVMI) and arterial stiffness index were measured and computed in 0 month, 12 months and 24 months. Results Compared to baseline value, LVMI was significantly decreased after initiation of antihypertensive therapy for 18 months (P<0.05).In comparison with group B, group A had lower LVMI in T6,T12,T18 and T24 (P<0.05).The group A had decreased chest thoracic ratio and brain natriuretic peptide value in T12,T18 and T24 when compared to those in group B (P<0.05). 24h systolic pressure variation, 24h diastolic pressure variation and arterial stiffness index were markedly reduced in T12 and T24 of group A when compared to parameters in group B. There was statistical significance regards to rate of readmission resulting from heart failure in two groups, 5.4% (group A) and 11.6% (group B) (P<0.05). Conclusion ARB can decrease LVMI and mitigate arterial stiffness in CAPD patients with left ventricular hypertrophy, as well as decrease rate of readmission resulting from heart failure.
keywords:Angiotensin receptor antagonist  Continuous ambulatory peritoneal dialysis  Left ventricular hypertrophy  Arterial stiffness index
查看全文  查看/发表评论  下载PDF阅读器

京公网安备 11010502037822号