血管紧张素转换酶抑制剂在肾移植中的应用

The application of angiotensin converting enzyme inhibitor administration in renal transplant recipients

目的探讨血管紧张素转换酶（ACE）抑制剂依那普利对同种异体肾移植患者移植肾远期功能的保护作用。方法2000—01-2001—06对肾移植术后时间达1年、移植肾功能正常、尿TGF—β1相对浓度≥250．0pg／mg．cr的22例患者（A组）连续使用依那普利（5mg／d）1年以上，与同期内、相同条件、未服用依那普利的23例患者（B组）作对比，观察两组肾功能的动态变化；3年后比较两组患者血和尿TGF—β1相对浓度、肌酐清除率（Ccr）减少量和肾功不全的病例数有无差异；比较A组服用依那普利前后，移植肾组织q-TGF—β1 mRNA表达量有无变化；观察服用依那普利的不良反应。结果B组Ccr进行性降低；在3年随访期内，A组Ccr减少（5.1±4.6）nd／min，有2例（9．1％）患者肾功能不全，均明显低于B组（P〈0．01、0．05），后者分别为（13．74-9．5）mE／rain和9（39、l％）例；3年后A、B两组尿TGF—β1浓度分别为（325．3±46．3、507.7±53．1）pg／mg．Cr，A组明显低于B组（P〈0.01）；两组血TGF—β1浓度差异无统计学意义（P〉0.05）；A组服用依那普利1年后，TGF—β1 mRNA表达量由（1．57±0．31）降为（0．94±0．27）；使用依那普利无不良反应发生；A、B两组中肾功不全者，穿剌活检证实均为慢性移植物肾病。结论依那普利对同种异体肾移植患者移植肾具有保护作用，其作用机理可能与降低移植肾内TGF—β1的分泌有关。

Objective To observe the protective role of enalapril as a specific angiotensin converting enzyme inhibitor on allograft in renal transplant recipients. Methods From Jan 2000 to Jun 2001,22 cases of renal transplant recipients with normal renal function and urine TGF- β1 concentration being higher than 250.0 pg/mg Cr（ group A） underwent therapy with angiotensin converting enzyme inhibitor （enalapril） one year after surgery. Enalapril was administered at a close of 50 mg/d for the patients in group A for at least one year. Twenty - three recipients who never received angiotensin converting enzyme inhibitor in the same condition were studied as Group B. The adverse reactions of enalapril were investigated in group A and the expression of TGF -β1 mRNA in renal grafts were compared between before and 1 year after enalapril therapy. At the end of 3 - year study period, the renal function, the decrement of creatinine clearance rate（Ccr） and the concentration of TGF- β1 in blood and urine were compared between the two groups respectively. Results The Ccr decreased faster in group B than in group A. During three years study period, the decrements of Ccr were （5.1± 4.6 ） and （ 13.7±9.5 ） （ml/min） in group A and group B respectively, and there were 2 cases and 9 eases with chronic allograft nephropathy （ CAN ） respectively. The decrement of Ccr and the number of CAN cases were significant difference between group A and group B（all P 〈0. 05）. The concentrations of urine TGF -β1 were （325.3 ±46. 3） and （507.7 ±53.1 ） （pg/mg. Cr） in group A and group B respectively 3 years after treatment with enalapril, with significant difference（ P 〈0. 01 ）. There was not significant difference in the concentration of blood TGF-β1 between the two groups. After treatment with enalapril for one year, the expression of TGF - β1 mRNA in Group A decreased from （ 1.57 ±0. 31 ） to （0. 94 ±0. 27）. No adverse reaction happened in the patients treated with enalaprd Conclusions There is a protective role of enalapril as a specific angiotensin converting enzyme inhibitor on allograft in renal transplant recipients, which is related with the decrease of the TGF - β1 in the kidney.