2种钙通道阻滞剂和3种血管紧张素转换酶抑制剂的近期肾保护作用比较

Comparison of 2 kinds of Calcium Channel Blockers with 3 kinds of Angiotensin Converting Enzyme Inhibitors on Short-term Renoprotective Effect

目的:研究钙通道阻滞剂(CCBs)和血管紧张素转换酶抑制剂(ACEIs)肾保护作用的差别。方法:原发性肾小球疾病患者104例。随机、配对分为氨氯地平组17例;马尼地平组19例;卡托普利组21例;西拉普利组24例;依那普利组23例。分别投与这5种药治疗4个月。治疗前、治疗后1,2,3和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、尿尿素氮以及尿蛋白选择指数(UPSI)。结果:5组患者治疗期间蛋白和食盐摄入量以及UPSI均无明显变化,各组间比较无明显差别;5组患者治疗后MAP均明显降低,但各组间比较无明显差别;治疗后尿蛋白、UAER和肌酐清除率(cCr),2个CCBs组比较均无明显变化,而3个ACEIs组均明显降低,但停药后恢复至治疗前水平,3组间比较无明显差别。结论:对原发性肾小球疾病患者,ACEIs有较好的近期肾保护作用,而CCBs效果不明显。

OBJECTIVE: To investigate the difference on renoprotective effect between calcium channel blockers(CCBs) and angiotensin converting enzyme inhibitors (ACEIs). METHODS:One hundred-four patients with primary glomerular diseases were randomized into 5 groups, treated with amlodipine (17 cases), manidipine (19 cases), captopril (21 cases),cilazapril (24 cases) and enalapril (23 cases), respectively, for 4 months. Mean arterial pressure (MAP), urinary protein, urinary albumin excretion rate (UAER), renal function, urinary sodium, urinary urea nitrogen and urinary protein selectivity index (UPSI) were measured before treatment, 1,2,3,4 months after treatment and 1 month after drugs withdrawal, respectively. RESULTS: The intakes of dietary protein and salt as well as UPSI had not difference during administration among 5 groups. MAP of all groups decreased significantly after treatment. There was no significant difference among the 5 groups. Urinary protein, UAER and cCr decreased markedly in patients treated with ACEIs, although they returned to the basic level after the drugs withdrawal. However, CCBs groups had little effect. CONCLUSION: This results suggest that ACEIs have short-term renoprotective effect on patients with primary glomerular diseases, while CCBs haven't.