双倍剂量ACEI、ARB及联合用药治疗蛋白尿疗效比较

A comparison of the therapeutic effects of double-dosage ACEI, ARB and their combination application in chronic nephropathy

目的比较双倍剂量血管紧张素转换酶抑制剂（ACEI）、血管紧张素I型受体拮抗剂（ARB）及二者联合用药对蛋白尿和延缓肾损害的疗效、安全性及差别。方法采用前瞻性、随机、对照研究。慢性肾脏病患者共60例，随机分为3组，每组20例。A组口服洛汀新20mg／d，初始剂量10mg／d；B组口服科素亚100mg／d，初始剂量50mg／d；C组口服洛汀新10mg／d加科素亚50mg／d，初始剂量分别为5mg／d、25mg／d。疗程均为6个月。观察治疗前后血压、24h尿蛋白定量、血肌酐（SCr）、血钾、肝功能及不良反应情况。结果3组患者治疗后血压均下降至130／80mmHg以下，治疗前后血压和伍用降压药平均种数组间比较无差异（P〉0．05）；3组减少尿蛋白的总有效率均〉95％，组间比较，总有效率无统计学差异；3组均无因副作用退出研究的病例。结论双倍剂量ACEI、ARB及二者联合用药对多种病因导致的轻、中度蛋白尿有显著疗效，能延缓肾损害进程；安全。

Objective To compare the effect of the double-dosage angiotensin converting enzyme inhibitor （ACEI）, double-dosage angiotension I receptor blocker （ARB） and their combination application in treatment of chronic nephropathy, such as reduction of proteinuria and the delay of progression of renal lesion, as well as their safety and differences. Method This research was made in a prospective, randomized and controlled manner. 60 cases of chronic nephropathy were divided randomly into three groups： group A, B and C, each group being consisted of 20 cases. Patients in group A received 20mg/d lotensin orally with the initial dose of 10mg/d; patients in group B were given 100mg/d losartan orally with the initial dose of 50mg/d; patients in group C adminstered 10mg/d lotensin ＋ 50m/d losartan by oral with the initial dose of 5mg/d lotensin ＋ 25mg/d losartan. The therapeutic course lasted for 6 months for the all thee groups. The target blood pressure was set to ≤130/80mmHg. Observations were made on the blood pressure before and after the treatment, the quantitation of 24 hours proteinuria, the level of serum creatinine （SCr） and serum potassium, hepatic function and adverse drug effects. Results No significant difference existed among the basic data （including sex, age, primary diseases, blood pressure, proteinuria, SCr, serum potassium, and hepatic function） for patients in the all three groups. The blood pressure dropped under the target value after the treatment for patients in the all three groups. No significant difference of the blood pressure existed among three groups and other groups treated by other hypotensives before and after the treatment （P〉0. 05）. The total effective rate for reducing proteinuria were over 95% in all three groups, but without significant statistical difference. No case in the three groups retreated from the study for the following reasons. Scr elevation exceeded the basic value more than 50% ; blood pressure elevation more than 5. 6 mmmHg; hepatic dysfumction; sustained hypotension; dizziness or postural hypotension, and ＇intolerable dry cough. Conclusions Application of the double-dosage ACEI, ARB and their combination may reduce significantly mild to medium proteinuria of chronic nephropathy caused by multiple pathological causes, and may retard the progress of renal lesion; besides, such treatment are safe and tolerable