【摘要】 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。更多还原

【Abstract】 OBJECTIVE:To explore the effects of long-term treatment with hydrochlorothiazide combined spironolactone on the activity of renin-angiotensin-aldosterone system(RAAS)and biochemical parameters in hypertensive patients.METHODS:A multicenter study was performed in patients with mild-moderate hypertension from nine Kai-luan coal mining industry hospitals.After 2-week placebo elution period and 6-week hydrochlorothiazide initiation period,the patients received hydrochlorothiazide(HCTZ)plus spironolactone for 5 years.The determination of the activity of RAAS was scheduled at the end of 2-week placebo elution period,at the end of 6-week HCTZ initiation period,at 2 and 5 years after treatment,respectively.And the biochemical parameters were determined annually.The RAAS and biochemical parameters at different time point were compared.RESULTS:At the end of 6-week HCTZ initiation period,plasma angiotensin-Ⅱ(AngⅡ)and aldosterone(ALD)concentrations in the hypertensive patients were significantly higher(P<0.01)while serum potassium was significant lower(P<0.05)compared with baseline values.At 2 years,plasma AngⅡ and ALD concentrations returned to baseline levels;and at 5 years,plasma AngⅡ and ALD concentrations showed no significance as compared with the baseline values wherease serum levels of potassium and sodium were down-regulated(P<0.01)while AngⅡ、ALD and glucose were not statistically different from baseline levels.CONCLUSION:Long-term use of hydrochlorothiazide combined spironolactone can reverse the activity of RAAS to baseline level and down-regulate serum levels of potassium and sodium yet with little impact on blood glucose concentration.更多还原