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目的比较血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻断剂(ARB)和钙离子通道阻断剂(CCB)对高血压病伴慢性肾功能不全(CKD)患者在介入术后发生造影剂肾病(CIN)的防治效果。方法回顾分析近6年南方医院内科病房180例高血压病伴CKD 2~3期患者,所有患者均接受了冠脉介入术,并在术前术后使用了水化治疗,术前至少使用了7 d的ACEI/ARB或CCB药物,另设单纯水化对照组;观察3组患者发生CIN的例数,以及术后24、48、72 h及7d的血清肌酐(SCr)、肌酐清除率(CCr)的变化水平,并记录肾功能恢复的时间。结果 ACEI/ARB组术后发生CIN 20例(占37%),CCB组术后发生CIN 16例(占20%),单纯水化组发生28例(占61%);与单纯水化组比较,两组术后CIN发生率均较低(P<0.05,P<0.01);CCB组和ACEI/ARB组比较,CCB组的CIN发生率较低(P<0.05)。3组患者介入术后24、48、72 h及7 d的SCr、CCr水平均有明显升高,差异有显著性;与单纯水化组相比,ACEI/ARB组和CCB组的血清SCr、CCr水平在24、48、72 h及7 d的时间点均有所降低,差异有显著性;CCB组与ACEI/ARB组相比,48、72 h及7 d的SCr降低较明显(均P<0.05)。术后14 d,ACEI/ARB组有14例(占70%)CIN患者肾功能恢复至术前水平,CCB组有12例(占75%),单纯水化组有16例(占62%),ACEI/ARB组和CCB比较差异无统计学意义。结论使用ACEI/ARB和CCB类药物均可对高血压病并发CKD患者发生CIN有预防作用;CCB类药物优于ACEI/ARB类药物。
Objective To compare the effects of angiotensin converting enzyme inhibitor (ACEI) / angiotensin receptor blocker (ARB) and calcium channel blocker (CCB) on patients with hypertension and chronic renal failure (CKD) After the contrast agent nephropathy (CIN) control effect. Methods A retrospective analysis of nearly 6 years Southern Hospital ward 180 cases of hypertensive disease with CKD stage 2 to 3 patients, all patients were treated with coronary intervention, and in the preoperative and postoperative use of hydration therapy, preoperative use of at least 7 days of ACEI / ARB or CCB drugs, another simple hydration control group; the number of cases of CIN were observed in three groups, and serum creatinine (SCr), creatinine clearance (24 hours, CCr) levels, and record the time of renal function recovery. Results CIN occurred in 20 cases (37%) in ACEI / ARB group, 16 cases (20%) in CIN group and 28 cases (61%) in simple hydration group. Compared with simple hydration group (P <0.05, P <0.01). The incidence of CIN in CCB group was lower than that in ACEI / ARB group (P <0.05). The levels of SCr and CCr in 24 hours, 48 hours, 72 hours and 7 days after intervention in 3 groups were significantly increased, the difference was significant; compared with the simple hydration group, serum SCr, CCr levels decreased at 24, 48, 72 and 7 d, with significant difference; compared with ACEI / ARB group, SCr decreased significantly at 48, 72 and 7 d <0.05). At 14 days after operation, 14 cases (70%) of ACEI / ARB group had renal function recovered to preoperative level, 12 cases (75%) in CCB group and 16 cases (62%) in simple hydration group , ACEI / ARB group and CCB no significant difference. Conclusions Both ACEI / ARB and CCB drugs can prevent CIN in hypertensive patients with CKD; CCB drugs are better than ACEI / ARB drugs.