原发性肾小球疾病患者血醛固酮变化及干预研究  

The changes and intervention of serum aldosterone level in patients with primary giomerular diseases

作　　者：邹军[1] 蒋更如[1] 朱汉威[1] 黄海东[1] 杜学亮[2] 

机构地区：[1]上海交通大学医学院附属新华医院肾内科,上海200092 [2]上海交通大学医学院附属新华医院核医学科,上海200092

出　　处：《临床肾脏病杂志》2007年第6期251-253,共3页Journal Of Clinical Nephrology

摘　　要：目的观察原发性肾小球疾病患者血醛固酮（Ald）水平的变化；探讨使用血管紧张素转化酶抑制剂（ACEI）与血管紧张素111型受体拮抗剂（AT1RA）干预后血Ald水平的变化。方法将75例原发性肾小球疾病患者依据内生肌酐清除率（Ccr）的不同分为3组，第1组Ccr≥60ml／min；第2组30ml／min≤Ccr〈60ml／min；第3组15ml／min〈Ccr〈30ml／min。比较3组血Ald水平，并分析其与Ccr的相关性。16例肾功能减退者洗脱4周后随机给予ACEI（10mg／d）或AT1RA（50mg／d）干预3个月；再次洗脱4周并交叉药物继续干预3个月；观察干预前、后血Ald的变化。结果第3组血Ald显著高于第1组和第2组，第2组血Ald也显著高于第1组，Ald水平与Ccr呈负相关；两种药物干预3个月后，血Ald水平均无明显下降（P〉0．05），两种干预之间也无显著差异（P〉0．05）。结论随着肾功能下降，原发性肾小球疾病患者血Ald逐渐升高；使用ACH、AT1RA3个月均不能有效降低原发性肾小球疾病患者血Ald水平。Objective To observe the change trend of serum aldosterone level in patients with primary glomerular diseases with varying degrees of renal insufficiency, and compare the effect of intervention between angiotensin-converting enzyme inhibitor（ACEI） and angiotensin Ⅱ type 1 receptor antagonist（AI1RA） on serum aldosterone in patients with primary glomerular diseases. Method 75 selected patients with primary glomerular diseases were assigned to three groups according to creatinine clearance rate （Ccr） calculated by Cockcroft-Gault formula; group 1 had Ccr more than 60 ml/min; group 2, between 30 and 60 ml/min; group 3, less than 30 ml/min but without renal replacement therapy. The levels of their serum aldosterone were compared and the correlation of Ccr and serum aldosterone was analyzed. 16 primary glomerular diseases patients with renal insufficiency were randomly assigned to be treated with benazepril 10 mg/day or losartan 50 mg/day and then crossed each other. Each treatment phase lasting 3 months was preceded by a fourweek washout period. Patients were evaluated at baseline and after each treatment phase. Results Serum aldosterone in group 3 was significantly higher than those in the former 2 groups, and group 2 was also significantly higher than group 1. There was a markedly negative correlation between Ccr and serum aldosterone; Serum aldosterone was not significantly reduced with treatment of either of the two drugs. There was also no significant difference between the two interventions. Conclusions Serum aldosterone level in patients with primary glomerular diseases may have a rising trend while their renal function drops. With treatment of 3 months, neither benazepril nor losartan in clinical commonly used dosage could reduce aldosterone in patients with primary glomenrular diseases.

关 键 词：醛固酮 肾小球疾病 原发性 血管紧张素转化酶抑制剂 血管紧张素Ⅱ1型受体阻断剂 

分 类 号：R972.4[医药卫生—药品] R128[医药卫生—药学]