洛沙坦治疗慢性移植物肾病的临床研究

Effect of Losartan on chronic allograft nephropathy

目的明确血管紧张素Ⅱ受体拮抗剂洛沙坦能否改善慢性移植物肾病患者的肾功能。方法2001年8月至2003年4月期间,对病理诊断为慢性移植物肾病(Ⅰ级)肾功不全的24例患者(组Ⅰ)使用洛沙坦治疗1年以上,与同期内未使用洛沙坦的27例慢性移植物肾病患者(组Ⅱ)进行对比,比较两组的肾功能、血和尿转移生长因子-β1(TGF-β1)浓度及使用洛沙坦的不良反应等。结果治疗1年后,组Ⅰ有15例(62.5%)患者移植肾功能得以好转或不再继续恶化,而组Ⅱ除6例(22.2%)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浓度及肾功能损失量均明显低于组Ⅱ,使用洛沙坦无不良反应发生。结论洛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-β1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 Twenty- four renal transplant recipients with CAN （group Ⅰ） were treated with losartan for at least one year. Other 27 patients with CAN （group Ⅱ） who weren＇t treated with losartan were used as control in the same period. Renal function, and blood and urine TGF- β1 concentrations were compared between the two groups. Results One year later, there were 15 patients （62.5 % ） with stabilized or improved graft function in group Ⅰ , and 6 patients （22.2 % ） in group Ⅱ . The difference was significant. Blood and urine TGF - β1 concentrations and renal function lost were lower in group Ⅰ than in group II. No side effects occurred in all patients in group Ⅰ, Conclusion Losartan can improve renal function among renal transplant recipients with chronic allograft nephropathy through reducing TGF-β1 secretion in the kidney.