缬沙坦治疗慢性移植物肾病21例

Renoprotective Effect of Angiotensin II Receptor Antagonists(AIIRA)-Valsartan on Patients with Chronic Allograft Nephropathy(CAN)

目的研究缬沙坦治疗慢性移植物肾病的疗效。方法将42例慢性移植物肾病患者随机分为治疗组和对照组各21例，两组在试验开始后1个月内逐渐将环孢素A、MMF和Prd的用量。试验组加用缬沙坦口服，80-160mg·d^-1。随访监测患者治疗前和治疗开始后第3，6，9，12个月的临床及生化指标，并分析治疗前和治疗第12月移植肾组织TGF-β1的表达。结果治疗组动脉血压、血肌酐、尿蛋白及尿中TGF-β1浓度均较治疗前显著降低（均P〈0．01），移植肾TGF-β1表达降低（P〈0.05）。对照组血肌酐上升速度减慢，但仍上升，其他生化指标及移植肾TGF-β1表达变化不明显。结论缬沙坦对慢性移植物肾病有较好的治疗作用。

Objective To study the renoprotective effect of valsartan on patients with chronic allograft nephropathy （CAN）. Methods Patients with CAN were randomly divided into two groups. In the control group （ n = 21 ） only immunosuppressive agents were adjusted, and in the therapy group （ n = 21 ） the patient would additionally take valsartan. Patient＇s clinical and biochemical parameters were recorded before treatment and at the 3 rd, 6^th, 9^th, and 12^th month follow-up after treatment. Before treatment and at the end of follow-up visit, the expressions of TGF-β1 in renal allograft were detected. Results In the therapy group, the patient＇ s clinical and biochemical parameters were improved, including decreased Scr, decreased MAP, decreased urine protein and decreased concentration of urine TGF-β1 （all P 〈0.01 ）. In the control group after therapy, there was a slowing down of serum creatinine ascending rate with other biochemical parameters changed insignificantly. The expression of TGF-β1 in allograft decreased significantly in the therapy group（ P 〈0.05） but changed insignificantly in the control group. Conclusion Valsartan has a high therapeutic renoprotective effect on renal transplant patients.