苯那普利对维持性透析患者残存肾功能的保护作用

Effect of Benazepril on Residual Renal Function in Maintenance Dialysis Patients

目的:探讨血管紧张素转换酶抑制剂(ACEI)能否延缓维持性透析患者残余肾功能的丢失。方法:将入选的血液透析患者60例及腹膜透析患者60例分别随机分入3组:大剂量贝那普利组(A组)、低剂量贝那普利组(B组),对照组(C组)。A组予苯那普利20-30mg/d,B组予苯那普利10mg/d,C组予ACEI/ARB之外的其他降压药。所有患者每3个月行残存肾功能(eGFR)测定,研究前后检测肌酐清除率(CCL),Kt/V,血红蛋白,血钾,并记录血压和24h尿量。结果:研究结束时,无论接受血透或腹透,A、B、C三组之间Kt/V,血红蛋白,血钾,血压水平差异无统计学意义。三组患者尿量均比研究前减少(P<0.05),C组减少最明显,依次为B组及A组,组间比较差异有统计学意义(P<0.05)。eGFR均明显下降,各组下降速度比较C组>B组>A组,组间差异有统计学意义。结论:苯那普利能有效延缓维持性透析患者残存肾功能的丢失。

Objective：To test the hypothesis whether the benazepril can slow the decline of residual renal function with end-stage renal failure treated with maintenance dialysis.Method：Sixty ESRD patients undergoing peritoneal dialysis and sixty undergoing regular hemodialysis were randomly assigned to the megadose benazepril group（group A,20 to 30 mg/d）,the small dose benazepril group（group B,10 mg/d） or the control group（group C）.The group C were given the hypotensor except ARB or ACEI.In all patients the eGFR were detected every three months,Kt /V,CCL,kalmia,hematoglobin concentration（HC） and blood pressure（BP） and urine amount of 24 hours were detected also before and after the experiment.Result：Over 12 months,the value of Kt /V,kalmia,HC,BP reduction were similar in the three groups.The urine amount of 24 hours in all groups were reduced,the steepest in the group C than in the other two groups,the steeper in group B than in group A,and all in statistical significance.At the end of the study,the value of the eGFR in all groups were declined in statistical significance,and the most depressed one in group C,the next in group B,then in group A.Conclusion：Benazepril can reduce the rate of decline of residual renal function in patients receiving maintenance dialysis.