螺内酯在伴肾上腺增生难治性高血压治疗中的疗效观察

Effect of spironolactone in the treatment of refractory hypertension with adrenal hyperplasia

关键词:  难治性高血压  肾上腺增生  螺内酯  疗效

Key words:  refractory hypertension  adrenal hyperplasia  spironolactone  curative effect

摘要:

目的探讨螺内酯在治疗伴肾上腺增生难治性高血压的临床疗效。方法将伴肾上腺增生难治性高血压患者随机分为两组：对照组：硝苯地平控释片30 mg＋坎地沙坦酯片8 mg+氢氯噻嗪片25 mg(n=54)，观察组：硝苯地平控释片30 mg＋坎地沙坦酯片8 mg+氢氯噻嗪片25 mg+螺内酯40 mg（n=54），分别在治疗后1个月、2个月、3个月监测血压、血钾、血尿酸、血肌酐、血糖等指标。评估两组治疗前后血压、血钾、肌酐、尿酸、血糖水平。结果　（1）治疗1个月、2个月、3个月两组患者收缩压、舒张压均有下降，与治疗前比较差异有统计学意义，观察组血压下降幅度明显低于对照组，差异有统计学意义（P<0.05）。（2）观察组显效率、有效率、无效率分别为66.7%、25.9%、7.4%；对照组分别为48.1%、33.3%、18.5%。总有效率观察组（92.6%）明显高于对照组（63.0%），差异有统计学意义（P<0.05）。（3）治疗前后两组血钾、肌酐、尿酸、血糖水平比较无统计学差异，虽然两组尿酸水平有升高趋势，但治疗前后比较差异无统计学意义（P>0.05）。结论在常规降压治疗基础上联用螺内酯能够降低伴肾上腺增生难治性高血压患者血压使更多的患者血压达标，且副作用没有明显增加，临床效果显著，值得推广。

Abstract:

Objective To investigate the clinical efficacy of spironolactone in the treatment of refractory hypertension with adrenal hyperplasia. Methods The patients with adrenal hyperplasia and refractory hypertension were randomly divided into 2 groups: control group (Nifedipine Controlled Release Tablets 30 mg+Candesartan Cilexetil Tablets 8 mg+ Hydrochlorothiazide Tablets 25 mg, n=54) and the observation group (Nifedipine Controlled Release Tablets 30 mg+Candesartan Cilexetil Tablets 8 mg+Hydrochlorothiazide Tablets 25 mg+ spironolactone 40 mg, n=54). The blood pressure, serum potassium, serum creatinine, serum uric acid and blood glucose levels were evaluated before and after treatment in two groups. Results Treatment were effective in both groups. Compared with the control group, blood pressure decreased more significantly in the observation group（P<0.05）. The remarkable efficiency, efficiency and inefficiency of the observation group were 66.7%, 25.9% and 7.4% respectively, while those in the control group were 48.1%, 33.3% and 18.5% respectively. The total effective rate in the observation group (92.6%) was significantly higher than that in the control group (63%) (P<0.05).There was no significant difference in serum potassium, serum creatinine,serum uric acid and blood glucose levels before and after treatment in two groups. Conclusion On the basis of the conventional antihypertensive treatment combined with spironolactone increases the effect of reducing blood pressure, which may be used in refractory hypertension patients with adrenal hyperplasia.