盐酸贝那普利对紫癜性肾炎降低尿蛋白的作用

Effect of Benazepril Hydrochloride on Proteinuria in Children with Henoch-Schonlein Purpura Nephritis

目的探讨盐酸贝那普利治疗紫癜性肾炎(HSPN)小儿降低尿蛋白的效果和安全性。观察治疗效应与病理类型、血管紧张素转换酶(ACE)基因多态性及治疗前24h尿蛋白定量的关系。方法HSPN患儿96例,按治疗方案不同分为2组:对照组32例对症处理;盐酸贝那普利组64例在对症处理基础上加用盐酸贝那普利,3.5～5.0岁3.5mg/d,5～7岁5mg/d,7～9岁7.5mg/d,9～16岁10mg/d,其中16例治疗1个月效应不佳,剂量增加至原剂量1倍。总疗程3个月。治疗前及治疗后0.5、2.0、3.0个月均监测血压、血清清蛋白、血BUN、Cr、电解质、24h尿蛋白定量等。治疗前用PCR法检测患儿ACE基因。结果盐酸贝那普利组降低尿蛋白疗效明显高于对照组(P<0.01),增加剂量降尿蛋白效应可增强。ACE基因DD型及II型降低尿蛋白疗效高于ID型;病理类型Ⅱ级病例组降尿蛋白疗效高于Ⅲ级(P<0.05);治疗前24h尿蛋白定量轻中度组降尿蛋白疗效高于重度组(P<0.01)。结论盐酸贝那普利可明显降低小儿HSPN蛋白尿,且有一定剂量相关性,安全可靠。治疗效应不仅与ACE基因多态性相关,更与病理类型及治疗前尿蛋白定量密切相关。

Objective To investigate the effect and safety of benazepril hydrochloride in treating renal proteinuria in children with Henoch-Schonlein purpura nephritis（HSPN）and observe its relation with pathological type,angiotensin-convertion enzyme（ACE）gene polymorphism and 24-hour proteinuria.Methods Ninety-six cases with HSPN were divided into 2 groups according to different treatment mothods.The control group（32 cases）was treated by conventional therapy,and the benazepril hydrochloride group（64 cases）was added with benazepril hydrochloride on the basis of the conventional therapy.The dose of benazepril hydrochloride was as following：3.5 mg/d（3.5-5.0 years old）,5 mg/d（5-7 years old）,7.5 mg/d（7-9 years old）,10 mg/d（9-16 years old）.There were 16 cases lack of effect after getting treated for 1 month and increased by double dose.The course of treatment was 3 months and the BP,serum albumen,BUN,Cr,electrolyte and quantitation of 24-hour proteinuria were measured by 0.5,2.0 and 3.0 months before and after treatment.ACE gene of patients was examined by PCR method before treatment.Results The curative effect of decreasing proteinuria in benazepril hydrochloride group was obviously higher than that of the control group（P〈0.01）and its effect paralleled with dose.The effect of proteinuria decrease in ACE gene type II and type DD were greater than that of type ID（P〈0.05）,and the effect in pathological type Ⅱ cases was higher than that of type Ⅲ.The effect of mild and middle quantitation of 24-hour proteinuria before treatment groups also better than that of serious group（P〈0.01）.Conclusions Benazepril hydrochloride can significantly and safely decrease proteinuria in children with HSPN.The effects is related to dose,ACE gene polymorphism,pathological type and the quantitation of 24-hour proteinuria before treatment.