难治性肾病肾小管功能损害及缬沙坦干预研究  

The significance of renal tubular dysfunction in patients with refractoriness nephritic syndrome and interference study with Valsartan

作　　者：杨焕荣[1] 蔡淑芳[1] 刘晓琴[1] 郝爱霞[1] 张洪生[1] 秦玉霞[1] 赵新莲[1] 

机构地区：[1]潍坊医学院附属青州医院肾内科,山东青州262500

出　　处：《中国医师杂志》2008年第4期505-508,共4页Journal of Chinese Physician

基　　金：山东省潍坊市科技发展计划基金资助项目（2006-02-30）

摘　　要：目的探讨肾小管功能损害在难治性肾病（RNS）中的意义及缬沙坦干预治疗对其影响。方法RNS患者阳例及正常对照68例，79例RNS患者随机分为缬沙坦组和潘生丁组，在常规治疗的基础上，缬沙坦组加缬沙坦（80mg／d），潘生丁组加潘生丁（150mg／d）治疗12周。治疗前后采用ELISA法、生化方法及肾间质病理计量分析法分别检测全部患者肾小管功能（尿RBP、α1-MG、β2-MG、mAlb、NAG）和肾间质病理改变。结果所有RNS患者尿RBP、α1-MG、β2-MG、mAlb、NAG明显高于正常对照组（P〈0．01）。且与肾小管间质损害均呈正相关（r=0．436、0．626、0．499、0．668、0．657，P〈0．01）。干预结果显示缬沙坦组口服缬沙坦后尿系列蛋白均明显降低，而潘生丁组则无明显变化。结论RNS患者均有不同程度的肾间质损害及肾小管功能的损害，而肾小管功能损害与肾间质损害及肾小球损害程度呈正相关。及早对RNS进行ARB干预治疗可改善肾小管功能及延缓RNS的发展。Objective To investigate the significance of renal tubular dysfunction in patients with refractoriness nephrotic syndrome （RNS） and the effect of interference treatment of Valsartan （VAL）. Methods 79 cases of RNS and 68 healthy controls were recruited into the study. The 79＂patients of RNS were divided randomly into the VAL group and the dipyridam group. On the basis of routine therapy, the VAL group was given VAL （80mg/d）, and the dipyridam group taken dipyridam （150mg/d） orally for 12 weeks. The glomerular tubular function （ u-RBP, α1 -MG, β2-MG, mAlb, NAG） were detected and the pathologic changes of tubulointerstitium were observed by using the methods of ELISA, biochemistry and scoring of the pathologic damage of tubulointerstitium before and after 12 weeks of VAL treatment in all of the cases. Results Urinary RBP, α1-MG, β2-MG, mAlb and NAG in all patients with RNS was evidently higher than that in healthy controls （ P 〈 0. 01 ）. Those had positive correlations with damages of tubulointerstitium （ r = 0. 436, 0. 626, 0. 499, 0. 668, 0. 657, P 〈 0. 01）. The interference outcome displayed that the excretion rates of urinary series of protein after oral use VAL in treatment group were markedly lower, while the control group had no distinct change. Conclusion There were various injury of tubulointerstitium and the disfigu- ration of renal tubular function in all cases with RNS. Damages of renal tubular function had positive correlation with tubulointerstitium injury and renal globular injury. Interference treatment with ARB in patients with RNS could improve renal tubular function, which is of great significance in delaying the progress of RNS.

关 键 词：肾病 肾小管/损伤/药物作用 缬氨酸/类似物和衍生物/治疗应用 

分 类 号：R692.6[医药卫生—泌尿科学]