高血压；_肾；_血管紧张素转换酶抑制药；

多普勒肾血流测定对不同降压药肾脏保护作用的随访

http://www.100md.com 《实用老年医学》 2006年第6期

高血压；,肾；,血管紧张素转换酶抑制药；,钙通道阻滞药；,肾循环,1资料与方法,2结果,参考文献

     【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。

    【主题词】高血压；肾；血管紧张素转换酶抑制药；钙通道阻滞药；肾循环

    Study on the renoprotective effect of antihypertensive drugs with ultrasound Doppler renal blood flow measurement FU Zhiqing, LI Xiaoying，Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing 100853 China；ZHOU Liaosheng, XU Rui, WANG Qing.Department of Cardiology； ZHANG Huaqing.Department of Ultrasound, Shandong Qianfoshan Hospital, Jinan 250014 China

    【Abstract】 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. Resukts 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. Conckusions Ultrasound Doppler renal blood flow measurement is one useful method in evaluating 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. ......

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