血管紧张素Ⅱ受体拮抗剂治疗慢性移植物肾病

The effect of Losartan on chronic allograft nephropathy

目的 :探讨血管紧张素Ⅱ受体拮抗剂氯沙坦能否改善慢性移植物肾病患者的肾功能。方法 :对病理诊断为慢性移植物肾病早期肾功不全的 18例患者 (组Ⅰ )使用洛沙坦治疗 1年以上 ,与同期内未使用氯沙坦的 2 3例慢性移植物肾病患者 (组Ⅱ )进行对比 ,比较两组的肾功能、血和尿TGF - β1浓度及使用氯沙坦的不良反应等。结果 :治疗 1年后 ,组Ⅰ有 12例 (6 7% )患者移植肾功能得以好转或不再继续恶化 ,而组Ⅱ除 4例 (17% )移植肾功能维持在原有水平外 ,其他患者肾功能均进行性恶化。组Ⅰ血和尿TGF - β1浓度及肾功损失量均明显低于组Ⅱ ,使用洛沙坦无不良反应发生。结论 :氯沙坦能改善部分慢性移植物肾病患者的肾功能 ,其药理作用可能与降低移植肾内TGF -pl的分泌有关。

Objective:To determine the efficacy of losartan a specific angiotensin Ⅱ receptor antagonist,in improving renal function among renal transplant recipients with chronic allograft nephropathy(CAN).Methods:18 renal transplant recipients with CAN (group Ⅰ)were treated with losartan for at least one year.Another 23 patients with CAN (group Ⅱ) while not treated with losartan were used as control in the same period.Renal function,blood and urine TGF-β 1 concentration were compared between the two groups.Results:One year later,there were 12 patients (67.0%) with stabilized or improved graft function in group Ⅰ,and 4 patients (17.0%) in group Ⅱ.The difference was significant.Blood and urine TGF-β 1 concentration and renal function lost were lower m group Ⅰ than in group Ⅱ.No side effects were noted in all patients in group Ⅰ.Conclusion:Losartan can improve renal fimction among renal transplant recipients with chronic allograft nephropathy through reducing TGF-β 1 secretion in the kidney.