论文部分内容阅读
目的:探讨氢氯噻嗪(HCTZ)与螺内酯长期联合治疗对高血压患者肾素-血管紧张素-醛固酮系统(RAAS)活性及生化指标的影响。方法:采用多中心研究,选择9所开滦矿区医院,筛选出轻、中度高血压患者。在2周的洗脱期和6周(HCTZ,12.5mg,qd)导入期后,服用HCTZ+螺内酯治疗5a。于洗脱期末和6周HCTZ导入期末、治疗2a、5a检测RAAS活性,每年检测血生化指标。比较各时间点RAAS活性变化与生化指标变化。结果:6周HCTZ导入期末,患者血浆血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)浓度较基线值显著升高(P<0.01),血钾浓度下降,差异有统计学意义(P<0.05);治疗2a时血浆AngⅡ和ALD浓度已恢复至基线水平;治疗5a后血糖、AngⅡ、ALD浓度变化与基线值比较差异无统计学意义,而血钾和血钠下降(P<0.01)。结论:长期合用HCTZ与螺内酯治疗后RAAS活性可恢复至治疗前水平,对血糖浓度影响不大,而血钾、血钠降低。
Objective: To investigate the effect of long-term combined treatment of hydrochlorothiazide (HCTZ) and spironolactone on the activity and biochemical indexes of renin-angiotensin-aldosterone system (RAAS) in patients with essential hypertension. Methods: Using multicentre study, 9 hospitals of Kailuan Mining Area were selected to screen mild and moderate hypertension patients. After 2 weeks of elution and 6 weeks (HCTZ, 12.5 mg, qd) lead-in period, HCTZ + spironolactone was administered for 5a. At the end of the elution period and at the end of 6 weeks of HCTZ introduction, RAAS activity was detected at 2a and 5a, and blood biochemical indexes were tested every year. The changes of RAAS activity and biochemical indexes were compared at different time points. Results: After six weeks of HCTZ induction, plasma Ang Ⅱ and aldosterone concentrations increased significantly (P <0.01) and serum potassium concentration decreased significantly (P <0.05) ; The levels of AngⅡ and ALD in plasma were restored to the baseline level after treatment for 2a. There was no significant difference in blood glucose, Ang Ⅱ and ALD concentrations after 5 years of treatment between the two groups (P <0.01). Conclusion: The activity of RAAS after HCTZ and spironolactone treatment for a long time can be restored to the level before treatment, with little effect on blood glucose concentration, but the serum potassium and serum sodium are decreased.