摘要
目的研究非糖尿病性慢性肾脏病(CKD)患者醛固酮逃逸的发生率及影响因素。方法选取本院2013年9月至2014年3月收治的非糖尿病性CKD 152例患者为研究对象,并给予血管紧张素Ⅱ受体拮抗剂(ARB)或ARB联合血管紧张素转化酶抑制剂(ACEI)治疗12个月,根据治疗前后醛固酮水平的变化,确定是否发生醛固酮逃逸。结果肾素-血管紧张素-醛固酮系统(RAAS)抑制剂治疗12个月时醛固酮逃逸的发生率显著高于治疗6个月时醛固酮逃逸的发生率(26.97%︰14.47%,P=0.007)。24小时尿蛋白基线值、估算肾小球滤过率(e GFR)基线值与RAAS抑制剂治疗12个月醛固酮逃逸的发生相关(分别为:OR=3.671,P=0.028;OR=0.972,P=0.019),e GFR基线值是醛固酮逃逸的独立预测因素(OR=0.970,P=0.012)。结论部分非糖尿病性CKD患者在RAAS抑制剂治疗后出现醛固酮逃逸,醛固酮逃逸的发生率随RAAS抑制剂治疗时间延长呈升高趋势。e GFR基线值是醛固酮逃逸发生的独立预测因素。
Objective To investigate the incidence and influencing factors of aldosterone breakthrough in patients with non-diabetic nephropathy after therapy with RAAS inhibitor. Method From September 2013 to March 2014, a total of 152 patients with non-diabetic nephropathy were treated with ARB or combination therapy of ACEI and ARB for a mean follow-up period of 12 months. Aldosterone breakthrough was determined according to the change of plasma aldosterone concentration before and after treatment during 6-month and 12-month ACEI/ARB treatment. Result In 12 months, the incidence of aldosterone breakthrough was significantly higher than that in 6 months(26.97% ︰ 14.47%, P = 0.007). Univariate Logistic regression demonstrated that risk factors of aldosterone breakthrough included pre-treatment values of the urinary protein excretion(OR = 3.671, P = 0.028) and e GFR(OR = 0.972, P = 0.019). Multivariate Logistic model revealed pre-treatment values of e GFR was positively associated with aldosterone breakthrough(OR = 0.970, P = 0.012). Conclusion The incidence of the aldosterone breakthrough increases with duration of treatment. Pre-treatment value of e GFR is independent risk factor of aldosterone breakthrough.
出处
《中国医学前沿杂志(电子版)》
2016年第3期60-63,共4页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)