大剂量ARB对肾移植后蛋白尿治疗作用的临床研究

High-dose angiotensin receptor blocker for the treatment of proteinuria in renal transplant recipients

目的观察大剂量ARB对肾移植后蛋白尿的疗效及安全性。方法83例肾移植后蛋白尿患者，分为治疗组50例（采用2～4倍剂量ARB治疗）和对照组33例（不使用ARB治疗），观察不同治疗时间两组患者24h尿蛋白、血肌酐、血生化、血压、远期人／肾生存率及药物不良反应。结果治疗组24h尿蛋白排出显著低于对照组；治疗组血肌酐倍增时间、进展到移植肾功能衰竭或死亡的时间显著高于对照组[（34．42±12．56）个月与（17．51±10．26）个月，（38,12±22．51）个月与（24．25±13．56）个月]；治疗组出现2例血钾升高，4例低血压。结论大剂量ARB可有效控制肾移植后蛋白尿，提高移植患者人／肾远期存活率，使用安全有效。

Objective To evaluate therapeutic effects and security of high-dose ARB angiotensin receptor blocker for the treatment of proteinuria in renal transplant recipients. Methods 83 cases of renal transplant recipients with persistent proteinuria （〉1.0g/d） were enrolled,with 50 cases in ARB group （treated with 2-4 times dosage of ARB） and others in control group（ treated without ARB）. Urine protein loss,serum creatinine and potassium,blood pressure, serum creatinine double time and time to reach end-stage renal failure were observed. Results ARB treatment markedly decreased urine protein loss. Serum creatinine double time and time for patients to reach end-stage renal failure or death were markedly prolonged in ARB group,with 2 cases of hyperkalemia and 4 cases of hypotension. Conclusion High dose angiotensin receptor blocker can effectively be used for the treatment of proteinuria in renal transplant recipients, with increase allograft/patient life span and high security.