Observation of curative effect of benazepril on polycythemia after kidney transplantation
-
摘要:
目的 观察贝那普利治疗肾移植术后红细胞增多症(PTE)的疗效及不良反应。 方法 选择2012年6月至2013年6月在解放军第309医院泌尿外科行首次肾移植术, 术后继发PTE的22例患者为研究对象, 根据有否高血压分为高血压组(14例)和正常血压组(8例)。高血压组给予贝那普利, 起始剂量为10 mg/d, 以后视病情变化最大剂量可增至40 mg/d; 正常血压组给予贝那普利5 mg/d, 血红蛋白及红细胞压积恢复正常后予以维持剂量2.5 mg/d。随访6个月比较两组患者服药后治疗效果和随访期间的不良反应。 结果 治疗6个月后, 高血压组显效12例、有效1例、进步1例; 正常血压组显效6例、有效1例、无效1例。两组疗效比较, 差异无统计学意义(P > 0.05)。治疗过程中高血压组患者血压明显下降(P < 0.05), 正常血压组患者血压未见明显变化。治疗前后两组患者的红细胞、中性粒细胞、血小板、血清肌酐、尿酸、估计肾小球滤过率等指标未见明显异常。高血压组中1例患者治疗期间出现刺激性咳嗽, 停药后恢复正常。 结论 肾移植术后PTE患者服用贝那普利治疗是安全有效的。应根据患者的血压从小剂量开始给药, 治疗过程中监测血压、血常规和肾功能, 根据血压调整药物剂量。 Abstract:Objective To observe the curative effect and adverse reaction of benazepril on polycythemia (PTE) after renal transplantation. Methods Twenty-two patients undergoing kidney transplantation for the first time at the Department of Urinary Surgery of the 309th Hospital of People's Liberation Army and developed PTE after renal transplantation from June 2012 to June 2013 were enrolled as the object of study. The patients were divided into the hypertension group (n=14) and the normal blood pressure group (n=8) according to whether the patients were with hypertension or not. The hypertension group was given benazepril with an initial dose of 10 mg/d and increased to the maximum dose of 40 mg/d according to the changes of patients' conditions. The normal blood pressure group was given benazepril with an initial dose of 5 mg/d and with the maintenance dose of 2.5 mg/d after hemoglobin and hematokrit returning to normal. The patients in two groups were followed up for 6 months. The curative effect and adverse reactions during the follow-up were compared between the two groups. Results After 6 months of treatment, 12 patients had marked effect, 1 had effect and 1 was improved in the hypertension group. Six patients had marked effect, 1 had effect and 1 had no effect in the normal blood pressure group. The difference of efficacy had no statistical significance between the two groups (P > 0.05). During the treatment, the blood pressure of the hypertension group dropped significantly (P < 0.05), while that of the normal blood pressure group had no significant change. Red blood cells, neutrophils, platelets, serum creatinine, uric acid and estimated glomerular filtration rate of the two groups had no obvious abnormality before and after treatment. One patient in the hypertension group developed irritable cough during the treatment and recovered after withdrawal. Conclusions It is safe and effective to take benazepril for patients with PTE after renal transplantation. It is recommended to start with small dose and the dose shall be adjusted according to blood pressure. The blood pressure, blood routine and renal function shall be monitored during the treatment. -
Key words:
- Benazepril /
- Renal transplantation /
- Polycythemia /
- Blood pressure
-
表 1 两组患者随访期间血压的动态变化
Table 1. Dynamic change of blood pressure of patients in two groups during the follow-up period (x±s, mmHg)
时间 高血压组(n=14) 正常血压组(n=8) 收缩压 舒张压 收缩压 舒张压 治疗前 147±8 87±8 121±9 77±5 治疗后2周 137±4a 83±5a 114±7 75±6 治疗后1个月 136±4a 81±4a 113±9 77±5 治疗后2个月 137±6a 82±5a 116±6 78±3 治疗后3个月 135±8a 80±6a 114±10 79±6 治疗后6个月 135±4a 81±5a 110±10 76±7 注:与治疗前比较,aP < 0.05 -
[1] Prakash J, Singh S, Behur SK, et al. Early posttransplant erythrocytosis in renal allograft recipients[J]. J Assoc Physicians India, 2010, 589:574-576. https://www.ncbi.nlm.nih.gov/pubmed/21391381 [2] Ahmed S, Ahmed E, Naqvi R, et al. Evaluation of contributing factors of post transplant erythrocytosis in renal transplant patients[J]. J Pak Med Assoc, 2012, 62(12):1326-1329. https://www.ncbi.nlm.nih.gov/pubmed/23866484 [3] 张潮, 石炳毅, 王振, 等.肾移植术后红细胞增多症65例临床分析[J].解放军医学杂志, 2013, 38(12):996-999. https://www.ncbi.nlm.nih.gov/pubmed/23866484Zhang C, Shi BY, Wang Z, et al. Clinical analysis of polycythemia after kidney transplantation:65 cases report[J]. Med J Chin PLA, 2013, 38(12):996-999. https://www.ncbi.nlm.nih.gov/pubmed/23866484 [4] 刘彦斌, 高建, 杨广庭, 等.肾移植术后红细胞增多症的中西医综合治疗(附82例报告)[J].器官移植, 2013, 4(2):95-97. http://www.cnki.com.cn/Article/CJFDTOTAL-QGYZ201302009.htmLiu YB, Gao J, Yang GT, et al. Comprehensive treatment of traditional Chinese and western medicine on erythrocytosis after renal transplantation (a report of 82 cases)[J]. Organ Transplant, 2013, 4(2):95-97. http://www.cnki.com.cn/Article/CJFDTOTAL-QGYZ201302009.htm [5] 许志坚, 麦伟民, 黄志清, 等.小剂量伊那普利治疗肾移植术后红细胞增多症的疗效与副反应观察[J].广东医学院学报, 2006, 24(5):454-455. http://www.cnki.com.cn/Article/CJFDTOTAL-GDYY200605005.htmXu ZJ, Mai WM, Huang ZQ, et al. Therapeutic efficacy of low dose of enalapril in polycythemia following renal transplantation[J]. J Guangdong Med Coll, 2006, 24(5):454-455. http://www.cnki.com.cn/Article/CJFDTOTAL-GDYY200605005.htm [6] 侯军, 薛武军, 田普训, 等.卡托普利治疗肾移植术后红细胞增多症患者的疗效观察[J].西安交通大学学报:医学版, 2005, 26(6):616. http://www.cnki.com.cn/Article/CJFDTOTAL-XAYX200506029.htmHou J, Xue WJ, Tian PX, et al. Treating erythrocytosis caused by renal transplantation with captopril[J]. J Xi'an Jiaotong Univ:Med Sci, 2005, 26(6):616. http://www.cnki.com.cn/Article/CJFDTOTAL-XAYX200506029.htm [7] 张亚莉, 王红艳, 柳红婷, 等.卡托普利治疗肾移植后继发性红细胞增多症临床观察[J].河北医药, 2005, 27(1):41. http://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ200501026.htmZhang YL, Wang HY, Liu HT, et al. Clinical observation on treatment of captopril on posttransplant erythrocytosis[J]. Hebei Med J, 2005, 27(1):41. http://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ200501026.htm [8] Vlahakos DV, Marathias KP, Agroyannis B, et al. Posttransplant erythrocytosis[J]. Kidney Int, 2003, 63(4):1187-1194. doi: 10.1046/j.1523-1755.2003.00850.x [9] 董隽, 敖建华, 肖序仁, 等.小剂量伊那普利治疗肾移植后红细胞增多症[J].中国医院药学杂志, 2001, 21(7):417-418. http://www.cnki.com.cn/Article/CJFDTOTAL-ZGYZ200107016.htmDong J, Ao JH, Xiao XR, et al. Treatment of low dose of enalapril on posttransplant erythrocytosis[J].Chin J Hosp Pham, 2001, 21(7):417-418. http://www.cnki.com.cn/Article/CJFDTOTAL-ZGYZ200107016.htm [10] Razeghi E, Kaboli A, Pezeshki ML, et al. Risk factors of erythrocytosis post renal transplantation[J]. Saudi J Kidney Dis Transpl, 2008, 19(4):559. https://www.ncbi.nlm.nih.gov/pubmed/18580013 [11] Charfeddine K, Zaghdane S, Yaich S, et al. Factors predisposing to post-renal transplant erythrocytosis:a retrospective study[J]. Saudi J Kidney Dis Transpl, 2008, 19(3):371-377. [12] 王文荣, 李秋芬.血液透析患者伴继发性红细胞增多症12例[J].实用医学杂志, 2012, 28(23):3963-3964. http://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201223044.htmWang WR, Li QF. Hemodialysis patients with secondary erythrocytosis:a report of 12 cases[J]. J Proct Med, 2012, 28(23):3963-3964. http://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201223044.htm [13] Kędzierska K, Kabat-Koperska J, Safranow K, et al. Influence of angiotensin I-converting enzyme polymorphism on development of post-transplant erythrocytosis in renal graft recipients[J]. Clin Transplant, 2008, 22(2):156-161. https://www.ncbi.nlm.nih.gov/pubmed/18339134 [14] Kiykim AA, Genctoy G, Horoz M, et al. Serum stem cell factor level in renal transplant recipients with posttransplant erythrocytosis[J]. Artificial Organs, 2009, 33(12):1086-1090. doi: 10.1111/j.1525-1594.2009.00823.x [15] Kessler M, Hestin D, Mayeux D, et al. Factors predisposing to post-renal transplant erythrocytosis. A prospective matched-pair control study[J]. Clin Nephrol, 1996, 45(2):83-89. https://www.ncbi.nlm.nih.gov/pubmed/8846535 [16] Trivedi H, Lal SM. A prospective, randomized, open labeled crossover trial of fosinopril and theophylline in post renal transplant erythrocytosis[J]. Ren Fail, 2003, 25(1):77-86. doi: 10.1081/JDI-120017470 [17] 马麟麟, 杨宇飞, 张玉海, 等.肾移植术后红细胞增多症的治疗[J].中华器官移植杂志, 2000, 21(3):141-142. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHQG200003005.htmMa LL, Yang YF, Zhang YH, et al. Treatment of posttransplantation erythrocitosis[J]. Chin J Organ Transplant, 2000, 21(3):141-142. http://www.cnki.com.cn/Article/CJFDTOTAL-ZHQG200003005.htm [18] 蒋雄京, 郑法雷, 康子琦, 等.卡托普利引起的移植肾急性肾功能衰竭4例报告并文献复习[J].北京医学, 1993, 15(4):209-211. http://www.cnki.com.cn/Article/CJFDTOTAL-BJYX199304005.htmJiang XJ, Zheng FL, Kang ZQ, et al. Acute renal failure of transplant kidney caused by captopril:4 cases report and literature review[J]. Beijing Med, 1993, 15(4):209-211. http://www.cnki.com.cn/Article/CJFDTOTAL-BJYX199304005.htm [19] 赵勇, 覃学勇, 丁军平, 等.贝那普利用于PTE的疗效及安全性的临床观察[J].现代泌尿外科杂志, 2005, 10(1):20-21. http://www.cnki.com.cn/Article/CJFDTOTAL-MNWK20050100C.htmZhao Y, Qin XY, Ding JP, et al. The clinical observation of the efficacy and safety of benazepril in the treatment of PTE[J]. J Mod Urol, 2005, 10(1):20-21. http://www.cnki.com.cn/Article/CJFDTOTAL-MNWK20050100C.htm