CAJ | 학술논문

目的观察氯沙坦对肾移植术后受者血红蛋白的影响,探讨其使用的安全性.方法选取肾移植术后超过3个月,移植肾功能稳定,有高血压的受者66例.随机将受者分为两组.实验组:34例,加用氯沙坦或使用氯沙坦替换原有的降压药物;对照组32例,不使用氯沙坦.分组后对受者进行6个月的观察,分别测定0(基础值)、1、2、3及6个月共5个时间点受者的血红蛋白、血肌酐、肾小球滤过率(GFR)及血压等指标,并观察各指标的变化趋势.结果实验组受者在使用氯沙坦1～2个月时的血红蛋白水平较基础值显著下降(P<0.05),2～6个月时趋于稳定;对照组受者的血红蛋白水平较基础值轻度上升(P>0.05).实验组中伴有高血红蛋白血症(PTE)的受者使用氯沙坦1～3个月时血红蛋白水平呈持续下降趋势(P<0.05),3～6个月时趋于稳定;对照组中伴有PTE的受者血红蛋白水平较基础值轻度下降(P>0.05).实验组中不伴有PTE的受者血红蛋白水平呈先下降后回升趋势;对照组中不伴有PTE的受者血红蛋白水平较基础值显著升高(P<0.05).实验组受者使用氯沙坦1个月时血肌酐水平呈升高趋势,2～6个月时逐渐恢复到基础值;对照组受者血肌酐水平无显著变化(P>0.05).实验组受者的GFR轻度下降后逐渐恢复到基础值;对照组受者的GFR呈逐渐上升趋势.实验组受者的血压呈明显下降趋势(P<0.05);对照组受者的血压较基础值无显著变化.结论肾移植术后使用氯沙坦能降低受者的高血红蛋白水平,对PTE有一定的治疗和预防作用,并且不会影响受者的移植肾功能.对于肾移植术后有高血压且发生高血红蛋白血症的受者,使用氯沙坦是安全的.
목적 관찰록사탄대신이식술후수자혈홍단백적영향,탐토기사용적안전성.방법 선취신이식술후초과3개월,이식신공능은정,유고혈압적수자66례.수궤장수자분위량조.실험조:34례,가용록사탄혹사용록사탄체환원유적강압약물;대조조32례,불사용록사탄.분조후대수자진행6개월적관찰,분별측정0(기출치)、1、2、3급6개월공5개시간점수자적혈홍단백、혈기항、신소구려과솔(GFR)급혈압등지표,병관찰각지표적변화추세.결과 실험조수자재사용록사탄1～2개월시적혈홍단백수평교기출치현저하강(P<0.05),2～6개월시추우은정;대조조수자적혈홍단백수평교기출치경도상승(P>0.05).실험조중반유고혈홍단백혈증(PTE)적수자사용록사탄1～3개월시혈홍단백수평정지속하강추세(P<0.05),3～6개월시추우은정;대조조중반유PTE적수자혈홍단백수평교기출치경도하강(P>0.05).실험조중불반유PTE적수자혈홍단백수평정선하강후회승추세;대조조중불반유PTE적수자혈홍단백수평교기출치현저승고(P<0.05).실험조수자사용록사탄1개월시혈기항수평정승고추세,2～6개월시축점회복도기출치;대조조수자혈기항수평무현저변화(P>0.05).실험조수자적GFR경도하강후축점회복도기출치;대조조수자적GFR정축점상승추세.실험조수자적혈압정명현하강추세(P<0.05);대조조수자적혈압교기출치무현저변화.결론 신이식술후사용록사탄능강저수자적고혈홍단백수평,대PTE유일정적치료화예방작용,병차불회영향수자적이식신공능.대우신이식술후유고혈압차발생고혈홍단백혈증적수자,사용록사탄시안전적.
Objective To evaluate the influence of losartan on levels of hemoglobin (Hb) in patients after renal transplantation. The safety of losartan in these patients was also evaluated. Methods Sixty-six hypertensive patients after renal transplantation with stable allograft function and serum creatinine levels below 176. 8 μmol/L (2 mg/dl) were divided into treatment group (n = 34) treated with losartan at a dose of 50 mg/d, and control group (n = 32) not treated with losartan. Each participant was followed up for 6 months, and differences in Hb, whole blood CsA trough concentration, blood pressure (BP), serum creatinine (Cr) and GFR were compared at baseline, and at the month 1, 2, 3 and 6. Results Serum Cr in treatment group showed a slight, hut significant increase at the month 1 (P<0.05 vs baseline), then gradually returned to the baseline until the month 6. Relatively, the estimated glomerular filtration rate (GFR) in treatment group was decreased slightly and temporarily. The Fib level in treatment group kept on dropping in the first two months (P <0.01 vs baseline), then remaining stable since the month 3. An uptrend of Hb was seen in the control group hut there was no statistically significant difference. For patients with Hb≥160 g/L, a progressive decrease in Hb was observed after losartan treatment (P<0.01 vs baseline), while a slight, non-significant decrease in the controls. For patients with Hb <160 μmol/L, Hb in treatment group was decreased in the first two months (P<0.01 vs baseline at the month 2), then gradually increased to baseline from the month 3 to 6. A progressive increase in Hb was seen in control group (P < 0.05 vs baseline). Conclusion Losartan can effectively and safely relieve and prevent posttransplantation erythrocytosis following renal transplantation.