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目的比较非洛地平(波依定)和福辛普利(蒙诺)治疗肾移植术后高血压的疗效及降压以外的作用。方法入选肾移植术后收缩压≥140mmHg和(或)舒张压≥90mmHg的患者67例,随机分为非洛地平组(n=33)和福辛普利组(n=34)。非洛地平组口服非洛地平2.5～10mg,1/d,如血压未降至140/90mmHg以下,稳定剂量服用1周以后可加用福辛普利治疗;福辛普利组口服福辛普利5～10mg,1/d,如血压仍高于140/90mmHg,在稳定剂量服用1周后可加用非洛地平治疗。随访4个月。观察血压、血肌酐及血红蛋白的变化。结果非洛地平和福辛普利降压效果相似(P>0.05)。但两者合用后血肌酐低于单用非洛地平亚组(P=0.013)和单用福辛普利亚组(P=0.010),血肌酐分别为(115.9±12.1)μmol/L、(131.0±21.1)μmol/L、(127.3±11.0)μmol/L。非洛地平组术后肾功能恢复时间低于福辛普利组(P=0.031),分别为(4.5±0.8)d和(5.0±0.8)d。单用非洛地平组发生红细胞增多症2例,多于联合应用福辛普利组(0例),进行亚组分析,有统计学意义(P=0.026)。结论肾移植术后高血压应用非洛地平和福辛普利联合治疗效果较好,且可以保护肾功能,预防红细胞增多症的发生。
Objective To compare the efficacy of felodipine and fosinopril in the treatment of hypertension after renal transplantation and the effects of antihypertensive drugs. Methods 67 patients with systolic blood pressure ≥140mmHg and / or diastolic blood pressure ≥90mmHg after renal transplantation were randomly divided into felodipine group (n = 33) and fosinopril group (n = 34). Felodipine group oral felodipine 2.5 ~ 10mg, 1 / d, such as blood pressure did not fall below 140 / 90mmHg, stable dose after 1 week can be added with fosinopril treatment; fosinopril group oral fosinopril Lee 5 ~ 10mg, 1 / d, such as blood pressure is still higher than 140 / 90mmHg, a stable dose of 1 week after taking felodipine treatment can be added. Followed up for 4 months. Observed blood pressure, serum creatinine and hemoglobin changes. Results felodipine and fosinopril antihypertensive effect was similar (P> 0.05). However, serum creatinine was (115.9 ± 12.1) μmol / L, serum creatinine was lower in the combination group (P = 0.013) and fosinopril alone group (P = 0.010) 131.0 ± 21.1) μmol / L, (127.3 ± 11.0) μmol / L. The time to recovery of renal function in felodipine group was lower than that in fosinopril group (P = 0.031), (4.5 ± 0.8) days and (5.0 ± 0.8) days, respectively. There were 2 cases of polycythemia with felodipine alone, more than the combination of fosinopril group (0 cases), subgroup analysis was statistically significant (P = 0.026). Conclusion The combination therapy of felodipine and fosinopril in patients with hypertension after renal transplantation is effective and can protect renal function and prevent the occurrence of polycythemia.