慢性肾脏疾病患者醛固酮逃逸的发生情况分析

Patients with chronic kidney disease occurrence aldosterone escape analysis

目的探讨服用血管紧张素酶(ACEI)和血管紧张素Ⅱ受体拮抗剂(ARB)治疗慢性肾脏疾病患者醛固酮逃逸的发生情况。方法选取2011年5月至2013年5月期间收治的采用ACEI/ARB治疗175例慢性肾脏疾病(CKD)患者为研究对象。所有患者均接受为期12个月的治疗,包括洗脱期、导入期及治疗期。记录治疗前、治疗后6个月、12个月血浆醛固酮、尿蛋白、肾小球滤过率(e GFR)浓度。分析治疗6个月及治疗12个月醛固酮逃逸的发生情况以及根据醛固酮逃逸与否分析尿蛋白、e GFR的差异。结果治疗12个月醛固酮逃逸的发生率明显高于治疗6个月(28.57%vs.14.29%),差异有统计学意义(P<0.05)。治疗12个月的非逃逸者尿蛋白差值较治疗6个月明显升高,差异具有统计学意义(P<0.05);而治疗12个月的逃逸者尿蛋白差值与治疗6个月相比,差异无统计学意义(P>0.05)。逃逸者治疗6个月、治疗12个月的尿蛋白差值与非逃逸者相比明显减少,治疗12个月的逃逸者的e GFR差值大于非逃逸者,差异有统计学意义(P<0.05)。结论 ACEI/ARB的长期使用会增加醛固酮逃逸的发生,因醛固酮逃逸可诱导肾小球损伤,会加快CKD的进展,对其的干预能改善CKD患者的预后。

Objective To investigate the aldosterone escape occurs in patients with chronic kidney disease. Methods 175 cases of chronic kidney disease （CKD） in our hospital during the period from May 2011 to May 2013 were included into this study. All these patients were considered as the research objects. All patients were treated for a period of 12 months, including the washout period, the import period and the treatmeut period. The plasma aldosterene, proteinuria, glomerular filtration rate （eGFR） concentrations were recorded before treatment, 6 and 12 months after treatment. Analysis for 6 months and 12 months of treatment, the occurrence of aldosterone escape aldosterone escape difference were performed according to the analysis of urine protein and eGFR. Results The incidence of aldosterone escape phenomenon after treatment 12 months was significantly higher than 6 months of treatment. The difference was statistically significant （28.57% vs. 14.29%, P 〈 0.05 ）. The non - escape urinary protein difference after 12 months treatment compared with six months of treatment significantly increased. The difference was statistically significant （ P 〈 0.05 ）. The escape of 12 months of treatment in urinary protein of treatment phase ratio is less than that of 6 months. The difference was not statistically significant （ P 〉 0.05 ）. Escape by treatment for 6 months, 12 months of treatment difference between urinary protein was significantly reduced compared to the non - escape. The escape treatment for 12 months eGFR difference is greater than those who were non - escape. The difference was statistically significant （ P 〈 0.05 ）. Conclusion The incidence of CKD patients using aldosterone escape RA- SI treatment at 12 months was significantly higher than the 6 months of treatment.