3种血管紧张素转化酶抑制剂肾保护作用比较

Comparson of three kinds of angiotensin converting enzyme inhibitors on renoprotective effect in primary glomerular diseases

目的 :探讨不同种类的ACEI对肾小球疾病的临床疗效。方法 :原发性肾小球疾病病人 54例。随机、配对分为Cap组 :captopril37.5mg·d- 1 ,1 6例 ;Cil组 :cilazapril 2 .5mg·d- 1 ,2 0例 ;Ena组 :enalapril 1 0mg·d- 1 ,1 8例。疗程 4个月。治疗前、治疗后 1 ,2 ,3 ,4个月及停药后 1个月检测平均动脉压 (MAP)、尿蛋白、尿白蛋白排泄率 (UAER)、肾功能、尿钠、尿尿素氮以及血和尿的转铁蛋白、IgG。结果 :3组病人观察治疗期间蛋白和食盐摄入量无明显变化 ,治疗后MAP、尿蛋白、UAER和Ccr均明显降低 ,但停药后恢复至治疗前水平 ,治疗期间血肌酐、尿蛋白选择指数均无明显变化 ,上述指标 3组间无明显差别。结论

OBJECTIVE To investigate the clinical effects of different ACEIs in primary glomerular diseases.METHODS In 54 patients with primary glomerular diseases, they received a 4 months therapy with ACEIs, including 16 cases with 37.5 mg·d -1 of captopril (Cap group) and 20 cases with 2.5 mg·d -1 of cilazapril (Cli group) and 18 cases with 10 mg·d -1 of enalapril (Ena group). The patients were mathched for age, sex, ACE gene polymorphism, pathological diagnoses and urinary protein, renal function,etc. Mean arterial pressure (MAP), urinary protein, urinary albumin excretion rate(UAER), renal function, urinary sodium, urinary urea nitrogen, plasma and urinary transferrin and IgG were measured at basis and after 1, 2, 3, 4 month of therapy and after 1 month of withdrawal.RESULTS There was unchange in dietary protein intake and salt intake whole therapy in all patients. The MAP, urinary protein, UAER and 24 hours creatinine clearance rate were reduced after ACEI therapy, but came back to basis after one month of withdrawal. The serum creatinine and urinary protein selectivity index were unchanged in observing course, and no difference among three groups.CONCLUSIONS The renoprotective effect of 3 kinds of ACEIs has no difference in primary glomerular diseases.