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目的探讨阿托伐他汀对高血压合并高低密度脂蛋白胆固醇(LDL-C)血症患者肾功能的影响。方法选择2013年6月至2014年12月福建省立医院老年科、心内科门诊和住院治疗的1、2级高血压合并高LDL-C血症患者154例,随机分为单纯降压组[78例,给予苯磺酸氨氯地平(5mg/d)降压治疗]和联合降压组[76例,在单纯降压治疗基础上加用阿托伐他汀(20mg/d)治疗],随访半年,观察两组治疗前后血压、估算的肾小球滤过率(eGFR)、尿微量白蛋白、LDL-C水平的变化情况。结果双因素重复测量方差分析显示,两组治疗前后血压的组间效应和交互效应差异无统计学意义(均P>0.05),而组内效应差异有统计学意义(均P<0.01)。与单纯降压组比较,联合降压组eGFR差值[(12.28±5.01)比(6.19±3.57)mL/(min·1.73 m~2)]、尿微量白蛋白差值[(28.65±13.97)比(21.36±13.62)mg/L]、LDL-C差值[(1.42±0.57)比(0.35±0.71)mmol/L]较大(均P<0.01)。多元线性回归分析结果显示,他汀类药物治疗和血压差值是治疗前后eGFR变化(B=5.23、0.10)和尿微量白蛋白变化(B=-6.03、-0.87;均P<0.01)的独立影响因素。结论阿托伐他汀对高血压合并高LDL-C血症患者具有独立于降脂作用之外的肾功能保护作用。
Objective To investigate the effect of atorvastatin on renal function in patients with hypertension and high and low density lipoprotein cholesterol (LDL-C). Methods From June 2013 to December 2014, 154 patients with grade 1,2 hypertension and high LDL-C in the Department of Geriatrics, Cardiology and Outpatient Department of Fujian Provincial Hospital were randomly divided into simple antihypertensive group [ 78 patients were given antihypertensive treatment with amlodipine besylate (5mg / d)] and combined with antihypertensive group [76 patients treated with atorvastatin (20mg / d) Six months after treatment, blood pressure, estimated glomerular filtration rate (eGFR), urinary albumin, LDL-C levels were observed before and after treatment. Results Two-way repeated measures ANOVA showed that there was no significant difference between the two groups in the inter-group effect and the reciprocal effect of blood pressure before and after treatment (all P> 0.05), while the intra-group effect was statistically significant (all P <0.01). The difference of eGFR between combined antihypertensive group and normal blood pressure group was (12.28 ± 5.01) vs (6.19 ± 3.57) mL / (min · 1.73 m ~ 2)], and urine microalbumin difference [(28.65 ± 13.97) (21.36 ± 13.62) mg / L], and the LDL-C difference (1.42 ± 0.57 vs 0.35 ± 0.71 mmol / L) was higher (all P <0.01). Multivariate linear regression analysis showed that statin treatment and BP differences were independent of changes in eGFR (B = 5.23, 0.10) and urine microalbumin (B = -6.03, -0.87; both P <0.01) before and after treatment factor. Conclusions Atorvastatin has renal function protection independent of lipid-lowering effect in patients with hypertension and high LDL-C.