CAJ | 학술논문

目的研究肾移植术后将钙通道阻滞剂(CCB)替换为血管紧张素受体阻滞剂(ARB)控制肾移植远期高血压和蛋白尿的有效性和安全性.方法将肾移植术后5～20年,并服用CCB药物治疗高血压的127例受者纳入研究,所有受者均无糖尿病,移植肾功能保持稳定.采用随机数字表法将受者分为2组,实验组65例,纳入研究前受者均单用CCB,纳入研究后停用CCB,改用氯沙坦50～100 mg/d;对照组62例,维持CCB用药不变.对两组受者进行随访,随访时间为2年,观察血、尿常规,肝、肾功能,血脂,电解质,24 h尿蛋白定量,以及CNI血药浓度等指标的变化.结果随访期间,两组受者的血压均能保持在正常水平.实验组受者24h尿蛋白定量由随访前的(176.32±54.54)mg下降至随访2年时的(155.69±62.25)mg,差异有统计学意义(P＜0.05)；随访2年时,对照组受者的尿蛋白水平略有上升,但差异无统计学意义(P＞0.05)；实验组受者的血脂水平与随访前相比,差异无统计学意义(P＞0.05),但高密度脂蛋白水平由随访前的(2.25±0.26)mmol/L升高到随访2年时的(2.46±0.31)mmol/L,差异有统计学意义(P＜0.05).两组受者随访前与随访2年后的血常规、肝肾功能、血钾及CNI血药浓度等检查指标的差异均无统计学意义.结论肾移植术后远期使用CCB和ARB治疗高血压都是安全、有效的,而应用ARB对于减少蛋白尿和降低心血管事件的风险可能会更好.
목적 연구신이식술후장개통도조체제(CCB)체환위혈관긴장소수체조체제(ARB)공제신이식원기고혈압화단백뇨적유효성화안전성.방법 장신이식술후5～20년,병복용CCB약물치료고혈압적127례수자납입연구,소유수자균무당뇨병,이식신공능보지은정.채용수궤수자표법장수자분위2조,실험조65례,납입연구전수자균단용CCB,납입연구후정용CCB,개용록사탄50～100 mg/d;대조조62례,유지CCB용약불변.대량조수자진행수방,수방시간위2년,관찰혈、뇨상규,간、신공능,혈지,전해질,24 h뇨단백정량,이급CNI혈약농도등지표적변화.결과 수방기간,량조수자적혈압균능보지재정상수평.실험조수자24h뇨단백정량유수방전적(176.32±54.54)mg하강지수방2년시적(155.69±62.25)mg,차이유통계학의의(P＜0.05)；수방2년시,대조조수자적뇨단백수평략유상승,단차이무통계학의의(P＞0.05)；실험조수자적혈지수평여수방전상비,차이무통계학의의(P＞0.05),단고밀도지단백수평유수방전적(2.25±0.26)mmol/L승고도수방2년시적(2.46±0.31)mmol/L,차이유통계학의의(P＜0.05).량조수자수방전여수방2년후적혈상규、간신공능、혈갑급CNI혈약농도등검사지표적차이균무통계학의의.결론 신이식술후원기사용CCB화ARB치료고혈압도시안전、유효적,이응용ARB대우감소단백뇨화강저심혈관사건적풍험가능회경호.
Objective To compare the efficacy and safety of conversion from CCB to ARB in the treatment of hypertension and proteinuria in kidney transplant recipients.Methods 127 long-term recipients who used CCB as their anti-hypertensive drug were enrolled.All recipients had stable renal function and no diabetes.Recipients were randomly assigned to experimental group (65 cases) which received ARB (Losartan,50～ 100 mg/day) instead of CCB,or control group (62 cases) which received routine CCB.All recipients were followed up for 2 years.Blood count,urinalysis,liver and kidney chemistry,blood lipid,serum electrolytes,24-h urine protein,blood concentration of CNI drugs and other biochemical indexes were observed.Results During the 2-year follow-up,the blood pressure of the two groups was maintained within normal level.The 24-h urine protein was decreased in the experimental group ( 176.32 ± 54.54 to 155.69 ± 62.25,P＜0.05),but increased slightly in the control group (P＞0.05).Although the blood lipid of the experimental group was not different before and after the follow-up,the high density lipoprotein (HDL) was increased statistically (2.25 ± 0.26 to 2.46 ±0.31,P＜0.05).The blood count,liver and kidney chemistry,serum potassium,blood concentration of CNI drugs in both groups showed no significant differences.Conclusion Both CCB and ARB could be effectively and safely used for the treatment of hypertension and proteinuria in kidney transplant recipients.ARB would be more effective in reducing cardiovascular disease (CVD)rate and decreasing proteinuria.