血管紧张素转换酶抑制剂对IgA肾病的疗效及影响因素分析

The effects of angiotensin-converting enzyme inhibitor on IgA nephropathy and the influencing factors

目的 观察血管紧张素转换酶抑制剂 (ACEI)对IgA肾病 (IgAN)的疗效及其影响因素。方法 131例IgAN患者随机分为治疗组和对照组 ,治疗组应用ACEI(苯那普利 10mg/d)治疗 ;对照组为非ACEI治疗组 ;对肾脏病理改变进行Lee氏分级并对各种病变进行半定量分析。结果 治疗组的显效率和总有效率均明显高于对照组 (P均 <0 0 5 ) ,治疗 1个月后治疗组尿蛋白即有显著下降 ,3个月时较 1个月时仍有明显下降 (P <0 0 5 ) ,6、18个月与 3个月时相比差异无显著性 ;血肌酐和肌酐清除率治疗前后比较无明显变化 ;对照组尿蛋白 1个月时有升高趋势 ,3个月后较治疗前升高且有显著性 (P均 <0 0 5 ) ;肌酐清除率 1个月时略有下降 ,3个月后与治疗前比较有显著下降 (P均<0 0 1)。单因素分析显示高血压、肾功能不全、Lee氏Ⅴ级、间质病变Ⅳ级、重度血管病变及肾小球硬化超过 75 %的患者 ,应用ACEI的疗效不如无高血压、肾功能正常、Lee氏Ⅰ～Ⅱ级、间质病变Ⅰ级、轻度血管病变和肾小球硬化小于 2 5 %的患者。多因素分析显示疗效与系膜增生程度呈正相关 ,与病程、肾小球硬化率及肾小动脉病变程度呈负相关。结论 应用ACEI治疗IgAN有明显降低蛋白尿和保护肾功能作用 ,影响疗效的主要因素为系膜增生程度、肾小球硬化率、肾小动脉病?

Objective To investigate the effects of angiotensin converting enzyme inhibitor (ACEI) on IgA nephropathy(IgAN) and the factors influencing the therapeutic effects Methods 131 cases with IgAN diagnosed by renal biopsy were randomly divided into two groups: ACEI group (benazepril 10 mg/d) and non ACEI group as control The pathological changes in the kidney were analyzed using Lee SMK Results After 1 month treatment of ACEI, the levels of proteinuria and serum cholesterol decreased significantly, meanwhile those of serum albumin and total protein increased obviously in patients with IgAN( P <0 05) The proteinuria level at the 3rd month after treatment was lower than that at the 1st month , but was same as that at the 18th month While in the control group the proteinuria level increased and the clearance of creatinine decreased continuously during the observation ( P <0 05) The effects correlated positively with mesangial proliferation and negatively with course of the disease?glomerular sclerosis in glomerulus and changes of small arterioles in the kidney Normal blood pressare?normal renal function?Ⅰ～Ⅱdegree of Lee SMK?Ⅰdegee of interstitial changes?minimal changes of small arterioles and mild glomerular sclerosis predicted better response to ACEI treatment than hypertension?renal insufficiency?Ⅴdegree of Lee SMK?Ⅳdegee of interstitial changes?severe changes of small arterioles and massive glomerular sclerosis Conclusions It is suggested that benezepril could definitely reduce the excretion of urinary protein and protect renal function of patients with IgAN and should be used as earlier as possible Mesangial proliferation?glomerular sclerosis in glomerulus ?changes of small arterioles in kidney and course of the disease are the major influencing factors of ACEI treatment on IgAN