雷公藤多苷联合氯沙坦或氨氯地平治疗肾移植后蛋白尿

Combined regime of Tripterygium wilfordii Hook.f.plus losartan or amlodipine in the treatment of proteinuria after renal transplantation

背景:蛋白尿和蛋白尿多少是影响移植肾功能存活的独立危险因素,雷公藤多苷或氯沙坦均有降尿蛋白作用。目的:观察雷公藤多苷联合氯沙坦或氨氯地平对治疗肾移植后蛋白尿的临床效果。方法:选择佛山市第一人民医院随访的肾移植后伴轻、中度高血压及蛋白尿患者40例,随机数字表法分为2组,雷公藤多苷+氯沙坦组口服雷公藤多苷0.5mg/(kg·d),氯沙坦50mg/d;雷公藤多苷+氨氯地平组口服雷公藤多苷0.5mg/(kg·d),氨氯地平5mg/d,要求血压控制在130/80mm Hg(1mm Hg=0.133 kPa)以下,观察治疗6个月,检测血压、肝肾功能、血尿常规,药物浓度,24h尿蛋白,药物不良反应。结果与结论:40例患者均进入结果分析,患者用药后收缩压、舒张压均显著下降(P<0.05),治疗6个月后,收缩压、舒张压均降至正常水平(P<0.01)。两组血压下降值、平均动脉压及治疗总有效率差异无显著性意义(P>0.05)。两组患者治疗前后血尿素氮、肌酐和血尿酸差异无显著性意义(P>0.05)。尿蛋白均减少,但差异亦无显著性意义(P>0.05);环孢素用量较前减少(P<0.05)。提示雷公藤多苷联合氯沙坦或氨氯地平用于肾移植后伴轻、中度高血压伴蛋白尿患者,能平稳降压,减少环孢素用量,减少蛋白尿,保护移植肾肾功能。

BACKGROUND:Proteinuria is an independent risk factor for grafted renal function after renal transplantation.Both Tripterygium wilforilii Hook.f.(TII) and losartan can reduce urine protein excretion.OBJECTIVE:To observe effect of combined regime of TII plus losartan or amlodipine on proteinuria after renal transplantation.METHODS:Forty patients with proteinuria and mild or moderate hypertension after renal transplantation were selected during the follow-up in Foshan First People's Hospital.The patients were divided into two groups according to random number table.The patients in the TII+losartan group took 0.5 mg/(kg·d) TII and 50 mg/d losartan;the patients in the TII+amlodipine group took 0.5 mg/(kg·d) TII and 50 mg/d amlodipine.The blood pressure was controlled under 130/80 mm Hg(1 mm Hg=0.133 kPa).After 6 months,the blood pressure,liver and renal function,blood and urine routine,drug concentration,urine protein of 24 hours and side effects of these drugs were tested.RESULTS AND CONCLUSION:The final analysis showed that the systolic pressure and diastolic pressure were remarkably decreased(P < 0.05);and after 6 months,the systolic pressure and diastolic pressure reached the aim values(P < 0.01).There was no obvious difference between these two groups in blood drop-out value,mean arterial pressure and the total effective rate(P > 0.05).There was no obvious difference of blood urea nitrogen,creatinine,and serum uric acid before and after treatment(P > 0.05).The urine protein was notably reduced in both groups after treatment,but there was no significant difference between two groups(P > 0.05).The dosage of cyclosporine was significantly reduced(P < 0.05).For the patients with proteinuria and mild or moderate hypertension after renal transplantation,the combined regime of TII plus losartan or amlodipine could release the blood pressure smoothly,reduce the proteinuria,descend the dosage of cyclosporine and meanwhile protect the renal functions.