依那普利对高血压病合并微白蛋白尿患者肾脏的保护作用

RENAL PROTECTIVE EFFECTS OF ENALAPRIL THERAPY IN ESSENTIAL HYPERTENSIVE PATIENTS WITH MICROALBUMINURIA AND LOW GLOMERULAR FILTRATION RATE

本文比较了24例高血压病Ⅱ期患者服依那普利(enalapril)4—6周前后某些肾功能:尿微量白蛋白排泄率,内生肌酐清除率,尿IgG排泄率、血与尿β_2微球蛋白。结果显示服药后血压,尿微量白蛋白排泄率及内生肌酐清除率均有明显改善。将24例分成正常(白蛋白排泄率<23mg/24h)及亚临床微量白蛋白尿组(23—100mg/24h),发现前组服药前后尿微量白蛋白排泄率无明显改变而后组明显减少(从54.2±35.5到28.8±27.8mg/24h)。此外,按内生肌酐清除率90 l/24h,将24例分成内生肌酐清除率降低组及正常组,发现服药后前组明显升高(从71.6±12.6到101.1±22.1 l/24h)而后组不明显。因此,依那普利对高血压病Ⅱ期合并有微量白蛋白尿及/或肾小球滤过率降低患者比无合并者有更明显的肾保护作用。作者并对其病理生理机制做了初步探讨。

The renal effects of enalapril treatment were evaluated in 24 essential hypertensivepatients with negntive or trace proteinuria (17 men, 7 women), 55.34±8.07 years, who belong toWHO stage II and were selected by routine examination. The patients first received placebo for twoweeks and then enalapril for 4-6 weeks (10-30mg/d). The renal effects observed included urinarymicroalbumin excretion (UMAE); creatinine clearance (CLcr), urinary microimmunoglobulin G ex-cretion (UMAE), urinary and serum β 2 microglobulin (β 2-MG). Systolic, diastolic blood pressure,UMAE and CLcr were significantly lowered or improved after enalapril administration (p<0.001,0.01, 0.05, respectively). There were positive correlations between microalbumin excretion and sys-tolic blood pressure before and after enalapril administration (r=0.483,p<0.05; r=0.857, p<0.01,respectively). The values of decreased blood pressure and decreased UMAE after enalapril were al-so associated positively (ΔSBP: r=0.497, p<0.01; ΔDBP: r=0.390, p<0.05). Matching con-trol subjects by age and sex, we took X±2SD (i. e. 23mg/24h) as the normal high limit. The sub-jects could thus be divided into two groups: (1)high (23-100mg/24h) or (2) normal microalbumin-uria. Before the administration of enalapril, the BP and UMAE of the first groups, correlated positive-ly (SBP: r=0.715, p<0.01; DBP: r=0.610, p<0.05)and after enalapril use, we found a de-crease of UMAE only in the firs group with high microalbuminuria but not in the normal level group(from 54.2±33.5mg/24h to 28.76±27.8mg/24h, p<0.05). In addition, the CLcr in those withdecreand CLcr group (n=18) was significantly increased after treatment from 71.59±12.59 to101.13±22. 13, p<0.001. No significant changes of 2 β-MG and UMGE were found afterenalapril. Thus, it was suggested that the angiotensin converting enzyme inhibitor, enalapril exhibits arenoptotective effect especially in those essential hypertensive potients with high microalbuminuria.