厄贝沙坦对早期肾功能损害老年患者肾脏的保护作用

The Protective Effect of Irbesartan on Renal Function in Elderly Patients with Early Renal Function Impairment

目的评价厄贝沙坦对伴有尿微量蛋白等早期肾功能损害的老年患者肾功能的保护作用。方法尿微量白蛋白升高的高血压或糖尿病老年患者均接受严格降压治疗。其中,连续应用厄贝沙坦治疗12个月者71例(厄贝沙坦组),未应用血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体阻滞剂类药物治疗者42例(对照组)。分析两组患者1年后尿微量白蛋白、尿α1微球蛋白、血清肌酐和肾小球滤过率等指标变化。结果两组收缩压和舒张压平均值均较基线水平有明显下降(P<0.05)。厄贝沙坦组尿α1微球蛋白和尿微量白蛋白较治疗前有显著下降(P<0.05)。其中,尿α1微球蛋白由18.4±6.5 mg/L降低到13.5±4.2 mg/L,下降了26.6%,尿微量白蛋白由78.3±12.7 mg/L降低到58.4±9.3 mg/L,下降了25.4%。对照组尿α1微球蛋白和尿微量白蛋白仅轻微下降(P均>0.05)。厄贝沙坦组和对照组治疗前后血清肌酐和肾小球滤过率未出现统计学意义的变化。结论对于老年高血压病或糖尿病患者,尿微量蛋白升高时,及时加用厄贝沙坦,有利于减轻蛋白尿的产生,延缓肾功能的损害。

Aim To evaluate the protective effect of irbesartan on renal function in elderly patients with microalbuminuria.Methods 113 old patients with microalbuminuria,who were suffered from hypertension or diabetes,were involved in the study.Patients were divided into two groups,irbesartan group or control group,all received strictly antihypertensive therapy with irbesartan or without any angiotensin-converting enzyme inhibitor（ACEI） or angiotensin receptor blocker（ARB）.Results The average levels of systolic blood pressure and diastolic blood pressure in two groups decreased significantly compared with baseline levels（P0.05）.But,the levels of blood pressure had little difference between the two groups（P0.05）.Urinary α1-microglobulin and urine microalbumin in irbesartan group after treated for 12 months were significantly decreased from 18.4±6.5 mg/L to 13.5±4.2 mg/L and from 78.3±12.7 mg/L to 58.4±9.3 mg/L,respectively（P0.05）.Meanwhile,there was no such a change in control group.The serum creatinine and glomerular filtration rate changed slightly after treatment for 12 months in two groups.Conclusion Irbesartan is beneficial to reduce urinary albumin and to protect renal function in elderly patients,who suffered from hypertension or diabetes mellitus.