血管紧张素转换酶抑制剂对单侧动脉粥样硬化性肾动脉狭窄患者肾功能的影响  

Effect of angiotensin-converting enzyme inhibitor on renal function in patients with unilateral atherosclerotic renovascular disease

作　　者：张欣[1] 王梅[1] 王海燕[1] 

机构地区：[1]北京大学第一医院肾内科,100034

出　　处：《中华肾脏病杂志》2005年第8期433-437,共5页Chinese Journal of Nephrology

基　　金：卫生部临床学科重点项目(20010913)

摘　　要：目的观察血管紧张素转换酶抑制剂(ACEI)对单侧动脉粥样硬化性肾动脉狭窄(ARAS)患者肾功能的影响。方法结合临床表现及肾动脉造影结果诊断单侧ARAS患者共49例,分为ACEI组20例与对照组29例。记录基础血压,检测Ser、BUN、Alb,以MDRD公式计算估计肾小球滤过率(eGFR),行肾动脉彩超检查测量肾脏阻力指数(RI)。每月测量血压,每6个月复查Scr、Urea、Alb并计算eGFR,观察两组患者随访期间肾功能变化。结果两组患者试验前一般临床资料元显著性差异。平均随访9.9个月,随访期间两组血压均无明显变化(P>0.05)。与试验前比,对照组eGFR无明显变化[(74.5±18.3)ml·min-1·(1.73m2)-1比(73.2±15.7)ml·min-1·(1.73m2)-1,P>0.05];而ACEI组eGFR下降明显[(69.3±14.6)ml·min-1·(1.732)-1比(63.5±16.4)ml·min-1·(1.73m2)-1,P<0.01]。观察结束时,ACEI组eGFR低于对照组[(63.5±16.4)ml·min-1·(1.73m2)-1比(73.2±15.7)ml·min-1·(1.73m2)-1,P<0.05]。ACEI组eGFR下降率(△eGFR%)明显高于对照组(-9.1%±6.8%比-0.6%±10.7%,P<0.01)。Pearson相关检验显示,基础eGFR、对侧肾脏RI与△eGFR%显著相关(r分别为0.583、-0.668,P<0.01)。结论对于单侧ARAS患者,当基础肾功能受损时,应用ACEI可能会导致肾功能下降,故应用时宜慎重,并定期监测肾功能。Objective To study the effect of angiotensin-converting enzyme inhibitor（ACEI） on renal function in patients with unilateral atherosclerotic renal artery stonosis （ARAS）. Methods From December 2002 to May 2004, 49 patients confirmed unilateral ARAS based on their clinical and angiography findings were divided into ACEI group （20 patients） and control group （29 patients）. The baseline blood pressure was recorded and baseline Scr,BUN,AIb were measured to calculate eGFR using MDRD equation. Blood presure was measured monthly, and eGFR was assessed every 6 months during follow-up All patients also received renal duplex ultrasoundgraphy to measure intrarenal resistance index（RI） at baseline. Results There were no statistic differences of baseline characteristics between two groups. The average follow-up period was 9.9 months. When compared with baseline data, no changes occured in blood pressure for both groups （P〉 0.05）; eGFR remained stable in control group[ （74.5±18.3）ml·min^-1· （1.73 m^2）^-1 vs （73.2±15.7）ml· min^-1· （ 1.73 m^2）^-1,P 〉 0.05 ], whereas it is significantly decreased in ACEI group[ （69.3±14.6）ml· min^-1. （1.73 m^2）^-1 vs （63.5±16.4）ml·min^-1·（1.73 m^2）^-1,P 〈 0.01]. At the end of observation, eGFR in ACEI group was lower [ （63.5±16.4）ml·min^-1. （1.73 m^2）^-1 vs （73.2±15.7）ml·min^-1. （1.73 m^2）^-1,P 〈 0.05],and the percentage of decrease of eGFR（△eGFR%） was higher（-9.1%±6.8% vs -0.6%±10.7%,P 〈 0.01） as compared with those of the control group. Pearson correlation analysis revealed that both baseline eGFR and contralateral R] were significantly correlated to △eGFR% （r=0.583 and -0.668, both P 〈 0.01）. Conclusion ACEI could be harmful to renal function in unilateral atherosclerotic renovascular patients with obvious renal parenchymal injury, and renal function should be monitored during using ACEI.

关 键 词：血管紧张素转换酶抑制剂 单侧动脉粥样硬化性肾动脉狭窄 肾功能 诊断 

分 类 号：R692.9[医药卫生—泌尿科学]