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Am J Kidney Dis:肾移植受者:氯噻酮VS氨氯地平哪个效果更好?

2017-06-15 闫盈盈;石岩 环球医学

2017年6月,发表在《Am J Kidney Dis》的一项由荷兰科学家进行的研究,得出了氯噻酮与氨氯地平对于他克莫司治疗的肾移植受者降压等效的结论。

2017年6月,发表在《Am J Kidney Dis》的一项由荷兰科学家进行的研究,得出了氯噻酮与氨氯地平对于他克莫司治疗的肾移植受者降压等效的结论。

背景:氯噻酮是一种非常有效的抗高血压药物,但是还没有在高血压的肾移植受者中进行过前瞻性研究。最近的数据表明,钙调磷酸酶抑制剂可激活噻嗪类敏感的氯化钠协同转运蛋白,为在该人群中噻嗪类药物提使用供了进一步的理论依据。

研究设计:随机、非劣效性、交叉试验(非劣效性边缘,-2.8mmHg)。

研究地点和参与者:使用他克莫司的高血压肾移植受者(肾移植后中位时间2.4年;平均估计肾小球滤过率,63±27(SD)mL/min/1.73m2;平均收缩压(SBP),151±12mmHg)。

干预:氨氯地平(5~10mg)和氯噻酮(12.5~25mg)治疗8周(另外有2周的洗脱期)。

结局:平均日间(早上9点到晚上9点)动态SBP。

测量:血压和实验室参数。

结果:88名患者进行了动态血压监测,入组了其中的49人(56%)平均日间SBP>140mmHg。41名患者完成了研究。8周后,氨氯地平和氯噻酮都降低了动态SBP(平均改变:150±12~137±12(SD)vs 151±12~141±13mmHg;效应大小:-4.2(95% CI,-7.3~1.1)mmHg)。尽管具有相似的血压应答,但是氯噻酮降低了30%的蛋白尿(效应大小:-65(95% CI,-108~-35)mg/g),也降低了医生评估的外周水肿(22%~10%;P都<0.05)。相反,氯噻酮暂时降低了肾功能,增加了血清尿酸和糖化血红蛋白水平。

局限性:开放标签设计、较短的随访期、按方案分析。

结论:肾移植后,氯噻酮与氨氯地平是同等有效的抗高血压药物。

原始出处:

Arthur D. Moes, Dennis A. Hesselink, et al. Chlorthalidone Versus Amlodipine for Hypertension in Kidney Transplant Recipients Treated With Tacrolimus: A Randomized Crossover Trial. American Journal of Kidney Diseases Volume 69, Issue 6, June 2017, Pages 796–804

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createdName=赵淘淘, createdTime=Thu Jun 15 17:19:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2018-02-10 mgqwxj
  3. 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createdName=赵淘淘, createdTime=Thu Jun 15 17:19:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-17 131****1460

    学习了,受益匪浅。

    0

  4. 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createdName=赵淘淘, createdTime=Thu Jun 15 17:19:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
  5. 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style='color:#2F92EE;'>#肾移植受者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82620, encryptionId=853182620c7, topicName=肾移植受者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4715034237, createdName=hjwang84, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1603053, encodeId=41de16030534d, content=<a href='/topic/show?id=81b91049067' target=_blank style='color:#2F92EE;'>#kidney#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10490, encryptionId=81b91049067, topicName=kidney)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c36e18990621, createdName=gwc389, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), 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createdName=赵淘淘, createdTime=Thu Jun 15 17:19:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=2012288, encodeId=40232012288c0, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Wed Feb 07 05:41:00 CST 2018, time=2018-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1928638, encodeId=fe7b192863857, content=<a href='/topic/show?id=12d46409214' target=_blank style='color:#2F92EE;'>#氯噻酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64092, encryptionId=12d46409214, topicName=氯噻酮)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=669d219, 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style='color:#2F92EE;'>#肾移植受者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82620, encryptionId=853182620c7, topicName=肾移植受者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4715034237, createdName=hjwang84, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1603053, encodeId=41de16030534d, content=<a href='/topic/show?id=81b91049067' target=_blank style='color:#2F92EE;'>#kidney#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10490, encryptionId=81b91049067, topicName=kidney)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c36e18990621, createdName=gwc389, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), 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createdName=赵淘淘, createdTime=Thu Jun 15 17:19:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2012288, encodeId=40232012288c0, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Wed Feb 07 05:41:00 CST 2018, time=2018-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1928638, encodeId=fe7b192863857, content=<a href='/topic/show?id=12d46409214' target=_blank style='color:#2F92EE;'>#氯噻酮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64092, encryptionId=12d46409214, topicName=氯噻酮)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=669d219, 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style='color:#2F92EE;'>#肾移植受者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82620, encryptionId=853182620c7, topicName=肾移植受者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4715034237, createdName=hjwang84, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1603053, encodeId=41de16030534d, content=<a href='/topic/show?id=81b91049067' target=_blank style='color:#2F92EE;'>#kidney#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10490, encryptionId=81b91049067, topicName=kidney)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c36e18990621, createdName=gwc389, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211237, encodeId=ce0a21123ee7, content=很好,谢谢,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:43:05 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211163, encodeId=409e211163b1, content=这个研究很有意义,值得借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDcohE5MKT1FYlH69x7qib45icLgBDMANxIh0DDaZibQ2wQL6WianQKpDacEu0ibD5KC4r1PLl1uUcZlaQ/0, createdBy=19ad2070095, createdName=赵淘淘, createdTime=Thu Jun 15 17:19:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-17 gwc389
  8. 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createdName=mgqwxj, createdTime=Sat Feb 10 19:41:00 CST 2018, time=2018-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=212002, encodeId=59db212002eb, content=学习了,受益匪浅。, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sat Jun 17 19:48:33 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1341279, encodeId=62dc13412e942, content=<a href='/topic/show?id=20bf640515d' target=_blank style='color:#2F92EE;'>#氨氯地平#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64051, encryptionId=20bf640515d, 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style='color:#2F92EE;'>#肾移植受者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82620, encryptionId=853182620c7, topicName=肾移植受者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4715034237, createdName=hjwang84, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1603053, encodeId=41de16030534d, content=<a href='/topic/show?id=81b91049067' target=_blank style='color:#2F92EE;'>#kidney#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10490, encryptionId=81b91049067, topicName=kidney)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c36e18990621, createdName=gwc389, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211237, encodeId=ce0a21123ee7, content=很好,谢谢,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:43:05 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211163, encodeId=409e211163b1, content=这个研究很有意义,值得借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDcohE5MKT1FYlH69x7qib45icLgBDMANxIh0DDaZibQ2wQL6WianQKpDacEu0ibD5KC4r1PLl1uUcZlaQ/0, createdBy=19ad2070095, createdName=赵淘淘, createdTime=Thu Jun 15 17:19:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-15 清风拂面

    很好,谢谢,学习了

    0

  9. 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topicName=氨氯地平)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/017ED6AFEB45F49165298113DDC0656A/100, createdBy=84182500174, createdName=ms7019579240139182, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1559875, encodeId=7e0615598e59c, content=<a href='/topic/show?id=853182620c7' target=_blank style='color:#2F92EE;'>#肾移植受者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82620, encryptionId=853182620c7, topicName=肾移植受者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4715034237, createdName=hjwang84, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1565884, encodeId=3bdc156588477, content=<a href='/topic/show?id=853182620c7' target=_blank style='color:#2F92EE;'>#肾移植受者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82620, encryptionId=853182620c7, topicName=肾移植受者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1c4715034237, createdName=hjwang84, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1603053, encodeId=41de16030534d, content=<a href='/topic/show?id=81b91049067' target=_blank style='color:#2F92EE;'>#kidney#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10490, encryptionId=81b91049067, topicName=kidney)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c36e18990621, createdName=gwc389, createdTime=Sat Jun 17 07:41:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211237, encodeId=ce0a21123ee7, content=很好,谢谢,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:43:05 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211163, encodeId=409e211163b1, content=这个研究很有意义,值得借鉴, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDcohE5MKT1FYlH69x7qib45icLgBDMANxIh0DDaZibQ2wQL6WianQKpDacEu0ibD5KC4r1PLl1uUcZlaQ/0, createdBy=19ad2070095, createdName=赵淘淘, createdTime=Thu Jun 15 17:19:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-15 赵淘淘

    这个研究很有意义,值得借鉴

    0

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