系统性硬化症肾损害患者血尿内皮素-1水平及其对依那普利治疗的反应

Serum and urine endothelin-1 in the systemic sclerosis patients with renal involvement and the response to enapril

目的检测系统性硬化症(SSc)伴/不伴临床肾损害的患者血清、尿内皮素-1(ET-1)水平有无差别,及其在依那普利治疗后的变化,以探讨ET-1在SSc肾损害中的作用。方法放射免疫法分析11例伴有临床肾损害表现的SSc患者(肾病组)血清、尿ET-1水平,并与23例不伴有临床肾损害表现的SSc患者(无肾病组)、15名健康人(健康对照组)相对比。并观察肾病组患者在依那普利治疗2周后血清、尿ET-1水平的变化。结果肾病组与无肾病组SSc患者血清、尿ET-1水平均高于健康对照组(P＜0．05)．但前两组患者血清ET-1水平差异无统计学意义(P＞0．05)。肾病组患者尿ET-1较无肾病组及健康对照组明显增加(P＜0．05),且肾病组患者尿ET-1的增加与该组患者内生肌酐清除率的下降呈显著负相关(r=-0．7737,P＜0．05)。肾病组患者在依那普利治疗2周后,血清ET-1无明显变化,尿ET-1明显下降(P＜0．05)。结论SSc患者肾脏中ET-1生成增加,伴有临床肾损害者尤其明显。肾脏ET-1的增加可能促进了SSc患者肾功能损害的发生、发展。使用依那普利治疗可明显减少肾脏ET-1的产生。

Objective To determine the serum and urine endothelin-1 levels （ET-1）in systemic sclerosis patients with renal involvement and the response to enapril. Methods Patients were categorized as renal involvement group （11） or without renal involvement group （23）. Serum and urine ET-1 levels were measured. Their levels were also measured in renal involvement group after enapril treatment. Fifteen healthy people were controls. Results Serum and urine endothelin-1 levels in renal involvement group and in renal-involvement-f ree group were higher than in controls, with no difference in serum ET-1 levels between the former two RP groups. However, urine ET-1 levels in renal involvement group were higher than those in renal-involvement-free group. After 2 weeks of enapril treatment, urine ET-1 levels in the renal involvement group were deceased. Conclusions These results support the hypothesis that ET-1 plays a key role in the pathogenesis of renal damage in systemic sclerosis. Enapril is a useful agent to attenuate the increased ET-1 levels in the kidney.