缬沙坦对维持性腹膜透析患者残存肾功能的保护及微炎症状态的影响

Effects of Valsartan on residual renal function and microinflammation in peritoneal dialysis patients

目的探讨血管紧张素II受体拮抗剂(ARB)缬沙坦能否延缓腹膜透析患者残存肾功能(RRF)的丢失及对其微炎症状态的影响。方法将入选的50例病情稳定的维持性腹膜透析患者随机分为缬沙坦组和对照组。缬沙坦组予缬沙坦80～160mg/d。所有患者每3个月行残存肾功能测定(RRF)及CRP检测,研究前后检测Kt/V、肌酐清除率(CCL)、血钾、血红蛋白,并记录血压和24h尿量。结果研究结束时,缬沙坦组和对照组的收缩压和舒张压、血红蛋白、血钾水平差异均有显著性;缬沙坦组CCL(单位:L/w/1.73m2)高于对照组,但对照组较缬沙坦组减少明显(P<0.05)。前6个月两组RRF都明显下降,6个月后缬沙坦组下降变缓,研究结束时缬沙坦组RRF较对照组高(P<0.05)。而从第3个月时研究组较缬沙坦组CRP较对照组高(P<0.05)。结论长期使用缬沙坦可以延缓腹透患者的残存肾功能的丢失及降低腹透患者微炎症状态。

Objective To explore whether the angiotensin Ⅱ receptor blocker Valsartan can slow the decline of residual renal function （RRF） and improve microinflammation in patients with end-stage renal failure （ESRD） treated with peritoneal dialysis. Methods Fifty ESRD patients undergoing regular continuous ambulatory peritoneal dialysis （CAPD）. were randomly assigned to Valsartan（80-160mg/d,n=26） or control group（n=24）. Conventional antihyperiensive treatment was continued in all patients to achieve the target BP in both groups of 120-135/70-85mmHg. Results Over 12 months, blood pressure （BP） reduction was similar in the Valsartan and control groups. Declining of The residual RRF was similar in the Valsartan and control groups during the first 6 months. At the end of the study, the value of residual RRF in Valsarta group was greater than that in control group （P〈0.05）. Valsartan could significantly slow the progressive declining of residual renal function. from the first 3 months. The levels of CRP in Valsarta were lower than thai in control group （P〈0.05）. Conclusion Valsartan may reduce the rate of decline of residual renal function and improve microinflammation in patients with regular peritoneal dialysis.