单用或联合应用硝苯地平缓释片与氨氯地平片对糖尿病肾病合并高血压患者的疗效及相关血清学指标的影响
|
摘要
目的探讨硝苯地平缓释片与氨氯地平片单用或联合应用治疗糖尿病肾病合并高血压患者的疗效及相关血清学指标的影响。方法糖尿病肾病合并高血压患者90例,随机分为三组,每组30例。一组采用硝苯地平缓释片治疗,一组采用苯磺酸氨氯地平片治疗,一组两药联合应用。治疗前和治疗3个月后对血压、血肌酐、尿素、24 h尿蛋白、超敏C反应蛋白、血清膀胱抑素和同型半胱氨酸的水平进行检测。所获数据采用方差分析、t检验和2检验。结果三组治疗前血尿素、血肌酐、24 h尿蛋白、收缩压、舒张压相互比较,P均>0.05。硝苯地平组治疗前后血尿素、血肌酐水平变化比较,P<0.0005;24 h尿蛋白、收缩压水平变化比较,P均>0.05;舒张压水平变化比较,P<0.005。氨氯地平组治疗前后血尿素、血肌酐水平变化比较,P均<0.0005;24 h尿蛋白水平变化比较,P<0.05;收缩压水平变化比较,P>0.05;舒张压水平变化比较,P<0.005。联合组治疗前后血尿素、血肌酐、24 h尿蛋白、收缩压、舒张压水平变化比较,P均<0.0005。硝苯地平组与氨氯地平组治疗后血尿素、24 h尿蛋白、收缩压、舒张压水平变化比较,P均>0.05;血肌酐水平变化比较,P<0.05。硝苯地平组与联合组治疗后血尿素、24 h尿蛋白、收缩压、舒张压水平变化比较,P均<0.0005;血肌酐水平变化比较,P<0.005。氨氯地平组与联合组治疗后血尿素、血肌酐、24 h尿蛋白、收缩压、舒张压水平变化比较,P均<0.0005。硝苯地平组与氨氯地平组治疗前超敏C反应蛋白、血清膀胱抑素、同型半胱氨酸水平比较,P均>0.05。硝苯地平组与联合组治疗前超敏C反应蛋白、血清膀胱抑素、同型半胱氨酸水平比较,P均>0.05。氨氯地平组与联合组治疗前超敏C反应蛋白、血清膀胱抑素、同型半胱氨酸水平比较,P均>0.05。硝苯地平组治疗前后超敏C反应蛋白、血清膀胱抑素、同型半胱氨酸水平变化比较,P均<0.0005。氨氯地平组治疗前后超敏C反应蛋白、血清膀胱抑素、同型半胱氨酸水平比较,P均<0.0005。联合组治疗前后超敏C反应蛋白、血清膀胱抑素、同型半胱氨酸平比较,P均<0.0005。硝苯地平组与氨氯地平组治疗后超敏C反应蛋白、血清膀胱抑素、同型半胱氨酸水平变化比较,P均>0.05。硝苯地平组与联合组治疗后超敏C反应蛋白水平变化比较,P<0.005;血清膀胱抑素、同型半胱氨酸水平变化比较,P均<0.0005。氨氯地平组与联合组治疗后超敏C反应蛋白水平变化比较,P<0.01;血清膀胱抑素、同型半胱氨酸水平变化比较,P均<0.0005。结论硝苯地平缓释片与氨氯地平片单用或联合治疗糖尿病肾病合并高血压患者可增强降压效果并明显降低蛋白尿,且副作用无明显增加,对血清超敏C反应蛋白、血清膀胱抑素、同型半胱氨酸具有明显的恢复功能,联合用药果更为显著,用药过程应时刻观察血压的变化,避免血压过低。
Objective To explore the effect of nifedipine sustained release tablets, amlodipine tablets and their combination on the efficacy and serological indexes of diabetic nephropathy patients with hypertension. Methods 90 patients with diabetic nephropathy and hypertension were randomly divided into three groups, 30 cases in each group. One group was treated with nifedipine sustained-release tablets, one group with amlodipine besylate tablets and one group with the combination of two drugs. Blood pressure, serum creatinine, urea, 24 h urine protein, high-sensitivity C-reactive protein(hs-CRP), serum cystatin(Cys) and homocysteine(Hcy) were measured before treatment and 3 months after treatment. The data were analyzed by variance analysis, t test and 2 test. Results Blood urea, serum creatinine, 24 h urine protein, systolic blood pressure and diastolic blood pressure were compared among the three groups before treatment with all P>0.05. The changes of serum urea and serum creatinine in nifedipine group before and after treatment were compared with P<0.0005; Comparison of 24 h urinary protein and systolic blood pressure were P>0.05; Comparison of diastolic blood pressure was P<0.005. The changes of serum urea and serum creatinine in amlodipine group before and after treatment were compared with P<0.0005; Comparison of 24 h urinary protein level was P<0.05; Comparison of systolic blood pressure was P>0.05; Comparison of diastolic blood pressure was P<0.005. The changes of the above indexes in the combined group before and after treatment were compared with P<0.0005. The changes of serum urea, 24 h urine protein, systolic pressure and diastolic pressure were compared between nifedipine group and amlodipine group after treatment with P>0.05; The serum creatinine levels were compared with P<0.05. The changes of serum urea, 24 h urine protein, systolic blood pressure and diastolic blood pressure were compared between nifedipine group and combination group after treatment with P<0.0005; Comparison of serum creatinine level was P<0.005. The changes of serum urea, serum creatinine, 24 h urine protein, systolic blood pressure and diastolic blood pressure were compared between amlodipine group and combination group with P<0.0005. The comparion of hs-CRP, Cys and Hcy between nifedipine group and amlodipine group, nifedipine group and combination group, amlodipine group and combination group before treatment were all P>0.05. The comparion of hs-CRP, Cys and Hcy in the three groups before and after treatment were all P<0.0005. The comparion of hs-CRP, Cys and Hcy between nifedipine group and amlodipine group after treatment were P>0.05. The comparion of hs-CRP between nifedipine group and combination group after treatment were P<0.005; comparison of Cys and Hcy were all P<0.0005. The comparion of hs-CRP between amlodipine group and combination group after treatment were P<0.01; comparison of Cys and Hcy were all P<0.0005. Conclusion Nifedipine sustained release tablets and amlodipine tablets alone or in combination can improve the antihypertensive effect and significantly reduce proteinuria in the treatment of diabetic nephropathy patients with hypertension, which had no obvious side effects. It can recover hs-CRP, Cys and Hcy obviously and the combined use had more obvious effect. However, we should observe the change of blood pressure in the process of medication and avoid low blood pressure.
Objective To explore the effect of nifedipine sustained release tablets, amlodipine tablets and their combination on the efficacy and serological indexes of diabetic nephropathy patients with hypertension. Methods 90 patients with diabetic nephropathy and hypertension were randomly divided into three groups, 30 cases in each group. One group was treated with nifedipine sustained-release tablets, one group with amlodipine besylate tablets and one group with the combination of two drugs. Blood pressure, serum creatinine, urea, 24 h urine protein, high-sensitivity C-reactive protein(hs-CRP), serum cystatin(Cys) and homocysteine(Hcy) were measured before treatment and 3 months after treatment. The data were analyzed by variance analysis, t test and 2 test. Results Blood urea, serum creatinine, 24 h urine protein, systolic blood pressure and diastolic blood pressure were compared among the three groups before treatment with all P>0.05. The changes of serum urea and serum creatinine in nifedipine group before and after treatment were compared with P<0.0005; Comparison of 24 h urinary protein and systolic blood pressure were P>0.05; Comparison of diastolic blood pressure was P<0.005. The changes of serum urea and serum creatinine in amlodipine group before and after treatment were compared with P<0.0005; Comparison of 24 h urinary protein level was P<0.05; Comparison of systolic blood pressure was P>0.05; Comparison of diastolic blood pressure was P<0.005. The changes of the above indexes in the combined group before and after treatment were compared with P<0.0005. The changes of serum urea, 24 h urine protein, systolic pressure and diastolic pressure were compared between nifedipine group and amlodipine group after treatment with P>0.05; The serum creatinine levels were compared with P<0.05. The changes of serum urea, 24 h urine protein, systolic blood pressure and diastolic blood pressure were compared between nifedipine group and combination group after treatment with P<0.0005; Comparison of serum creatinine level was P<0.005. The changes of serum urea, serum creatinine, 24 h urine protein, systolic blood pressure and diastolic blood pressure were compared between amlodipine group and combination group with P<0.0005. The comparion of hs-CRP, Cys and Hcy between nifedipine group and amlodipine group, nifedipine group and combination group, amlodipine group and combination group before treatment were all P>0.05. The comparion of hs-CRP, Cys and Hcy in the three groups before and after treatment were all P<0.0005. The comparion of hs-CRP, Cys and Hcy between nifedipine group and amlodipine group after treatment were P>0.05. The comparion of hs-CRP between nifedipine group and combination group after treatment were P<0.005; comparison of Cys and Hcy were all P<0.0005. The comparion of hs-CRP between amlodipine group and combination group after treatment were P<0.01; comparison of Cys and Hcy were all P<0.0005. Conclusion Nifedipine sustained release tablets and amlodipine tablets alone or in combination can improve the antihypertensive effect and significantly reduce proteinuria in the treatment of diabetic nephropathy patients with hypertension, which had no obvious side effects. It can recover hs-CRP, Cys and Hcy obviously and the combined use had more obvious effect. However, we should observe the change of blood pressure in the process of medication and avoid low blood pressure.
引文
[1]卢妙心,朱颖霞,吴莹,等.缬沙坦联合阿托伐他汀治疗早期糖尿病肾病对微量白蛋白尿的影响[J].广东医学,2014,35(23):3735-3736.
[2]唐岚.叶酸对老年H型高血压患者血浆同型半胱氨酸和hs-CRP水平及心血管事件的影响[J].河北医药,2016,38(7):968-971.
[3]孙署平,不同剂量缬沙坦联合氨氯地平治疗老年高血压的临床效果评价[J].中国医药导报,2014,11(4):81-83.
[4]林彩云,陈武,何淑芬.硝苯地平控释片联合缬沙坦治疗老年2型糖尿病肾病合并高血压的效果[J].山东医药,2017,57(5):84-86.
[5]袁腾飞,李艳,彭锐.慢性肾脏病患者血清hs-CRP水平的变化及临床意义[J].海南医学,2017,28(5):769-771.
[6]杨君,钱东林.厄贝沙坦联合钙离子拮抗剂治疗老年2型糖尿病肾病合并高血压的疗效观察[J].河北医学,2014,20(12):2002-2004.
[7]沈晓伟,张海波.苯磺酸氨氯地平与硝苯地平治疗高血压的疗效比较[J].中国处方药,,2017,15(8):75-76.
[8]赵春芳.硝苯地平缓释片对高血压治疗的临床疗效观察[J].中国实用医药,2017,12(28):103-105.
[9]王毅,庄建芬,刘君,等.硝苯地平控释片联合缬沙坦治疗老年高血压合并糖尿病肾病病人的疗效[J].实用老年医学,2017,31(9):881-882.
[10]潘丽梅.缬沙坦联合硝苯地平治疗高血压的临床效果[J].中华临床医师杂志(电子版),2017,(7):1234-1236.
[2]唐岚.叶酸对老年H型高血压患者血浆同型半胱氨酸和hs-CRP水平及心血管事件的影响[J].河北医药,2016,38(7):968-971.
[3]孙署平,不同剂量缬沙坦联合氨氯地平治疗老年高血压的临床效果评价[J].中国医药导报,2014,11(4):81-83.
[4]林彩云,陈武,何淑芬.硝苯地平控释片联合缬沙坦治疗老年2型糖尿病肾病合并高血压的效果[J].山东医药,2017,57(5):84-86.
[5]袁腾飞,李艳,彭锐.慢性肾脏病患者血清hs-CRP水平的变化及临床意义[J].海南医学,2017,28(5):769-771.
[6]杨君,钱东林.厄贝沙坦联合钙离子拮抗剂治疗老年2型糖尿病肾病合并高血压的疗效观察[J].河北医学,2014,20(12):2002-2004.
[7]沈晓伟,张海波.苯磺酸氨氯地平与硝苯地平治疗高血压的疗效比较[J].中国处方药,,2017,15(8):75-76.
[8]赵春芳.硝苯地平缓释片对高血压治疗的临床疗效观察[J].中国实用医药,2017,12(28):103-105.
[9]王毅,庄建芬,刘君,等.硝苯地平控释片联合缬沙坦治疗老年高血压合并糖尿病肾病病人的疗效[J].实用老年医学,2017,31(9):881-882.
[10]潘丽梅.缬沙坦联合硝苯地平治疗高血压的临床效果[J].中华临床医师杂志(电子版),2017,(7):1234-1236.