RAAS抑制剂治疗后非糖尿病性慢性肾脏病患者醛固酮逃逸的发生率及影响因素

Incidence and influencing factors of aldosterone breakthrough in patients with non-diabetic nephropathy after therapy with RAAS inhibitor

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.