高剂量缬沙坦单独或联合贝拉普利对慢性肾病的疗效  

Effect of High Dose of Valsartan,Single or Combined with Lotensin in Chronic Kidney Disease

作　　者：李超[1] 娄探奇[1] 汤颖[1] 游宇平[1] 马小琨[1] 

机构地区：[1]中山大学附属第三医院肾脏内科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2006年第3期354-357,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省重大专项及重点项目(B30302)

摘　　要：目的观察大剂量血管紧张素受体拮抗剂单独、或联合血管紧张素转换酶抑制剂治疗慢性肾小球肾炎及糖尿病肾病的疗效和安全性。方法40例病人按随机数字表分2组,缬沙坦组(n=20)服用缬沙坦(valsartan)320mg/d,联合组(n=20)服用盐酸贝拉普利(benazeprilhydrochloride)20mg/d联合缬沙坦160mg/d,疗程6个月。观察24h尿蛋白、血清肌酐、血压及血钾变化及不良反应情况。结果6个月缬沙坦组24h尿蛋白由治疗前(2.2±1.5)g/d降到(0.7±0.7)g/d(P<0.05),联合组由(2.4±1.2)g/d降到(0.7±1.1)g/d(P<0.05),比较两组降尿蛋白疗效虽未达统计学意义(P>0.05),但联合治疗有更好的降尿蛋白倾向。两组均能有效降低血压,联合组降舒张压优于缬沙坦组。干咳、血钾升高和血肌酐升高是导致中止治疗的主要原因。结论大剂量血管紧张素拮抗剂单独或联合血管紧张素转换酶抑制剂治疗慢性肾脏病安全,两者均可有效减少尿蛋白,联合治疗双重阻断肾素血管紧张素系统有叠加的减少尿蛋白及降血压倾向。[Objective] To observe the effect and safety of high dose valsartan single or combined with benazepril hydrochloride （lotensin） on patients with chronic nephritis and diabetic nephropathy. [Methods] Forty patients were enrolled and assigned to two groups at random. Patients took valsartan 320 mg/d in ARB group （n-- 20）,or lotensin 20 mg/d plus volsartan 160 mg/d in combined therapy group （n=20）over six months. Blood pressure,urine protein,serum creatine, serum potassium and adverse-effects were detected during the trial. [Result] After six months therapy, 24 hour proteinuria decreased from （2.2±1.5） g/d to （0.7±0.7）g/d（P〈 0.05） in ARB group, and from （2.4±1.2） g/d to （0.7±l.1）g/d （P〈 0.05） in combined group. Combined ACEI and ARB had a greater proteinuria reduction, though no statistical difference （P 〉0.05）. Cough,hyperkalemia and serum creatinine significant increasing were the main reason of withdrawall from the triM. [Conclusion] High dose or dual renin anglotensin system blockade can effectively and safely play a role in proteinuria reduction and renoprotection. Combined therapy has better effect of lowering proteinueia and blood pressure.

关 键 词：血管紧张素转换酶抑制剂 血管紧张素受体拮抗剂 慢性肾脏病 

分 类 号：R692[医药卫生—泌尿科学]