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目的:观察阿托伐他汀对老年高血压肾病患者肾脏血流动力学及肾功能的影响。方法:选择56例老年高血压肾病患者随机给予常规治疗(对照组)及常规+阿托伐他汀治疗(阿托伐他汀组),治疗前和治疗1、6个月时查诊室血压、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转移酶(ALT)、肌酸激酶(CK)、血肌酐、24 h尿蛋白定量,并估算肾小球滤过率(eGFR);治疗前和治疗6个月时采用彩色多普勒超声测定治疗前后肾血流动力学的变化。结果:阿托伐他汀组患者LDL-C水平1个月及6个月时均较治疗前明显降低(P<0.05),与对照组间差异显著(P<0.01);24 h尿蛋白定量1个月时无明显变化,6个月时阿托伐他汀组与对照组较治疗前均明显降低(P<0.05),阿托伐他汀组降低更加明显,两组间差异显著(P<0.05);血肌酐及eGFR 1个月时无变化,6个月时阿托伐他汀组较治疗前血肌酐有所降低,eGFR有所升高,但差异无显著性(P>0.05),治疗前后差值与对照组比较,差异显著(P<0.05);两组治疗前后双侧肾动脉(RA)、段动脉(SRA)、叶间动脉(IRA)的收缩期最大流速(PSV)无显著变化,6个月时治疗组各级动脉舒张末期最低流速(EDV)较治疗前明显升高(P<0.05),阻力指数(RI)较治疗前明显降低(P<0.05),治疗前后差值与对照组比较差异显著(P<0.05),RA的EDV差异特别显著(P<0.01)。结论:阿托伐他汀对老年高血压肾病患者有肾脏保护作用,降低肾动脉血管阻力,改善肾血管结构,可能是其肾保护机制之一。
Objective: To observe the effects of atorvastatin on renal hemodynamics and renal function in elderly hypertensive nephropathy patients. Methods: Fifty-six elderly patients with hypertensive nephropathy were randomly assigned to receive conventional therapy (control group) and conventional atorvastatin (atorvastatin group). Before treatment and at 1,6 months of treatment, blood pressure, low density (LDL-C), alanine aminotransferase (ALT), creatine kinase (CK), serum creatinine, 24 h urinary protein, glomerular filtration rate (eGFR) The changes of renal hemodynamics before and after treatment were measured by color Doppler sonography at 6 months. Results: The level of LDL-C in atorvastatin group was significantly lower than that before treatment at 1 month and 6 months (P <0.01) (P <0.05). Atorvastatin group decreased more obviously at 6 months, with significant difference between the two groups (P <0.05). Atorvastatin group and control group were significantly lower than those before treatment ; Serum creatinine and eGFR did not change at 1 month. At 6 months, serum creatinine in atorvastatin group was decreased and eGFR was increased, but the difference was not significant (P> 0.05), before and after treatment (P <0.05). Before and after treatment, the maximum systolic velocity (PSV) of bilateral renal arteries (RA), segmental arteries (SRA) and interlobar arteries (IRA) At 6 months, the mean arterial end-diastolic velocity (EDV) of the treatment group was significantly higher than that before treatment (P <0.05), and the RI was significantly lower than that before treatment (P <0.05) (P <0.05). The difference of EDV in RA was significant (P <0.01). Conclusion: Atorvastatin has renal protective effect on elderly patients with hypertensive nephropathy, reducing renal vascular resistance and improving renal vascular structure may be one of the mechanisms of renal protection.