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目的 评价氯沙坦在治疗慢性肾功能不全伴高血压时对肾脏的保护作用。方法 40例慢性肾功能不全伴高血压患者 ,2 0例接受氯沙坦 (Los)治疗 ,2 0例接受苯那普利 (Ben)治疗 ,对照观察 4周。治疗前后测血压、肾功能、内生肌酐清除率、2 4h尿蛋白定量。结果 Los与Ben组的降压有效率分别为 95 %、90 % ,但差异无显著性(P >0 .0 5 )。两组治疗前后血清肌酐、尿素氮及内生肌酐清除率均无明显变化。氯沙坦可降低血尿酸水平 ,与治疗前对照有显著差异 (P <0 .0 1) ;苯那普利不影响血清尿酸。两组治疗后 2 4h尿蛋白均较治疗前减少 (P <0 .0 5 )。氯沙坦不良反应轻微。结论 氯沙坦对高血压患者慢性肾功能代偿与失代偿期有效 ,且副作用小 ,与利尿剂合用其降压效果可增强 ;氯沙坦有肾脏保护作用。
Objective To evaluate the protective effect of losartan on the kidney in the treatment of chronic renal insufficiency and hypertension. Methods Twenty patients with chronic renal insufficiency and hypertension were enrolled in the study. Twenty patients were treated with losartan and twenty with benazepril. The patients were followed up for 4 weeks. Before and after treatment, blood pressure, renal function, creatinine clearance rate, 24 h urine protein quantitation. Results The effective rate of lowering blood pressure in Los and Ben group was 95% and 90% respectively, but the difference was not significant (P> 0.05). Before and after treatment, serum creatinine, urea nitrogen and endogenous creatinine clearance rate did not change significantly. Losartan reduced serum uric acid levels, which was significantly different from the control before treatment (P <0.01). Benazepril did not affect serum uric acid. Urine protein in both groups decreased 24 h after treatment (P <0.05). Losartan adverse reactions were mild. Conclusions Losartan is effective in patients with essential hypertension with chronic renal decompensation and decompensation. The side effects of losartan are small, and its antihypertensive effect can be enhanced with diuretics. Losartan has renal protective effect.