钙通道阻滞剂在小儿肾移植受者中的应用。

Use of calcium-channel blockers in pediatric renal transplant recipients.

作者信息

Silverstein D M, Palmer J, Baluarte H J, Brass C, Conley S B, Polinsky M S

机构信息

Department of Pediatrics, St Christopher's Hospital for Children, Medical College of Pennsylvania/Hahnemann School of Medicine, Philadelphia, USA.

出版信息

Pediatr Transplant. 1999 Nov;3(4):288-92. doi: 10.1034/j.1399-3046.1999.00056.x.

DOI:10.1034/j.1399-3046.1999.00056.x

PMID:10562973

Abstract

Hypertension (HTN) is a significant problem in pediatric renal transplant (TP) recipients, predisposing the individuals to the development of cardiovascular disease and graft dysfunction. Calcium channel blockers (CCB) are considered excellent agents to treat post-TP HTN. We compared the efficacy and adverse effects of the two most commonly prescribed CCBs in our pediatric renal TP population: nifedipine (Procardia, or P) and amlodipine (Norvasc, or N). All patients (n = 24) had been started on a CCB for systolic (SBP) and/or diastolic BP (DBP) > 95%. There were no other changes in adjunctive antihypertensive medications or doses during the cross-over period. Post-TP, pretreatment (pretx) SBP was 137.6 +/- 10.9 mmHg. The post-treatment SBP were (in mmHg): 128.5 +/- 11.9 (all patients, n = 24) (p = 0.009 vs. pretx); 126.4 +/- 10.0 (P alone, n = 15) (p = 0.007 vs. pretx); 132.8 +/- 14.4 (P + other antihypertensive(s), n = 9) (p = 0.331, NS vs. pretx). The post-TP, pretreatment DBP was 88.2 +/- 11.1 mmHg. The post-treatment DBP were (in mmHg): 78.5 +/- 6.9 (all patients, n = 24) (p = 0.03 vs. pretx); 77.2 +/- 7.4 (P alone, n = 15) (p = 0.008 vs. pretx); 80.7 +/- 6.1 (P + other antihypertensive(s), n = 9) (p = 0.063, NS vs. pretx). P and N were equally effective in reducing SBP (p = 0.843, NS) and DBP (p = 0.612, NS). Cyclosporin A (CyA) dose (p = 0.81) and trough levels (p = 0.19) were similar in P- and N-treated patients. Calculated GFR was virtually identical in P- and N-treated patients (p = 0.89). Patients (or parents of) reported a higher incidence of various side-effects while receiving P, including headache, flushing, dizziness and leg cramps. Furthermore, 22/24 (91.7%) reported some degree of gingival hyperplasia during treatment with P, and all these patients reported a stabilization or reduction of hypertrophy after the switch from P to N. We conclude that CCBs (N) are efficacious drugs for the purpose of BP control and renal protection in pediatric renal TP recipients.

摘要

高血压（HTN）是小儿肾移植（TP）受者中的一个重要问题，使个体易患心血管疾病和移植肾功能障碍。钙通道阻滞剂（CCB）被认为是治疗肾移植后高血压的理想药物。我们比较了在我们的小儿肾移植人群中最常用的两种CCB的疗效和不良反应：硝苯地平（心痛定，或P）和氨氯地平（络活喜，或N）。所有患者（n = 24）因收缩压（SBP）和/或舒张压（DBP）> 95%开始使用CCB治疗。在交叉期，辅助降压药物或剂量没有其他变化。肾移植后，治疗前（pretx）SBP为137.6±10.9 mmHg。治疗后的SBP（以mmHg为单位）为：128.5±11.9（所有患者，n = 24）（与pretx相比，p = 0.009）；126.4±10.0（仅使用P，n = 15）（与pretx相比，p = 0.007）；132.8±14.4（P + 其他降压药，n = 9）（与pretx相比，p = 0.331，无统计学意义）。肾移植后，治疗前DBP为88.2±11.1 mmHg。治疗后的DBP（以mmHg为单位）为：78.5±6.9（所有患者，n = 24）（与pretx相比,p = 0.03）；77.2±7.4（仅使用P，n = 15）（与pretx相比，p = 0.008）；80.7±6.1（P + 其他降压药，n = 9）（与pretx相比，p = 0.063，无统计学意义）。P和N在降低SBP（p = 0.843，无统计学意义）和DBP（p = 0.612，无统计学意义）方面同样有效。环孢素A（CyA）剂量（p = 0.81）和谷浓度（p = 0.19）在P治疗组和N治疗组患者中相似。计算得出的肾小球滤过率在P治疗组和N治疗组患者中几乎相同（p = 0.89）。患者（或其父母）报告在接受P治疗时各种副作用的发生率较高，包括头痛、脸红、头晕和腿部痉挛。此外，22/24（91.7%）的患者报告在使用P治疗期间有一定程度的牙龈增生，并且所有这些患者在从P转换为N后报告增生稳定或减轻。我们得出结论，CCB（N）是小儿肾移植受者控制血压和肾脏保护的有效药物。