洛沙坦预防慢性移植物肾病的临床研究

The Effect of Losartan on Preventing Chronic Allograft Nephropathy

【目的】探讨血管紧张素Ⅱ受体拮抗剂洛沙坦对慢性移植物肾病 (CAN)的预防作用。【方法】检测138例肾功能正常的肾移植患者尿转移生长因子β1(TGF β1)的相对浓度 ,即尿TGF β1/尿肌酐 (pg/mg) ,将浓度 >2 5 0 .0pg/mg的 38例随机分为A、B两组 ,各 19例。A组连续服用洛沙坦 (5 0mg/d) 1年以上 ,B组除了未服用洛沙坦外 ,其他治疗与A组相同。两组前瞻性观察至少 3年 ,比较两组尿TGF β1相对浓度、肌酐清除率 (CCr)减少量和肾功不良 (血肌酐 >114 μmol/L)患者的病例数有无差异。【结果】B组肾功能进行性减退、尿TGF β1进行性升高 ;在 3年内A、B两组CCr减少量和肾功不良者的病例数分别为 (6 .9± 5 .7)ml/min、(13.8± 9.6 )ml/min和 3例、11例 ,两组比较有显著性差异 ;A、B两组中肾功不良的患者 ,穿刺活检证实均为CAN ;A组服用洛沙坦后无不良反应。【结论】洛沙坦对CAN具有预防作用。

Objective To observe whether losartan, a specific angiotensin Ⅱ receptor antagonist, has a role in preventing chronic allograft nephropathy (CAN) in renal transplant recipients.Urine TGF-β 1 concentration was tested in 138 renal transplant recipients with normal renal function. Thirty eight recipients whose urine TGF-β 1 concentrations were higher than 250.0 pg/mg were studied. They were divided equally into two groups randomly. 19 cases in each. Group A was treated with losartan for at least 1 years, and in group B losartan was not used, as control.Renal function and urine TGF-β 1 concentration were compared between the two groups.Three years later, there were more loss of renal function and more number of CAN cases in group B than group A. Urine TGF-β 1 concentration in group B grew gradually. The differences in the two groups were significant. No side effects were noted in all patients who had taken losartan.[Conclusion]Losartan can prevent CAN in renal transplant recipients through reducing TGF-β 1 secretion in the kidney.