血管紧张素受体阻断剂对慢性肾病患者尿蛋白、脂质代谢及炎症因子的影响  

Effects of Angiotensin Receptor Blockers on Proteinuria,Lipid Metabolism and Inflammatory Factors in patient with Chronic Glomerular Disease

作　　者：杨沿浪[1] 张道友[1] 陈卫东[2] 黄杨杨 李龙海[4] 汪裕伟[1] 朱新俭[1] 徐海红[1] 杨利才[1] 

机构地区：[1]皖南医学院附属弋矶山医院肾内科,安徽省芜湖市241001 [2]蚌埠医学院附属医院肾内科,安徽省蚌埠市233000 [3]马鞍山钢铁公司总医院肾内科,安徽省马鞍山市243003 [4]阜阳市第二人民医院肾内科,安徽省阜阳市236037

出　　处：《中国动脉硬化杂志》2008年第6期476-478,共3页Chinese Journal of Arteriosclerosis

基　　金：安徽省首批学术技术带头人基金(2002HBL25)

摘　　要：目的观察血管紧张素系统阻断荆对慢性肾脏疾病患者脂质代谢、血管紧张素Ⅱ、白细胞介素1及C反应蛋白水平的的影响。方法89例伴有蛋白尿的慢性肾小球疾病患者随机分为三组：苯那普利组（n=30）、缬沙坦组（n=30）和联合治疗（苯那普利＋缬沙坦）组（n=29），治疗8～12周。分别检测血脂、血管紧张素Ⅱ、白细胞介素1和C反应蛋白水平及24h尿蛋白定量。结果治疗后各组血清总胆固醇水平显著降低；联合治疗组甘油三酯水平显著降低（P〈0．05）；苯那普利组和联合治疗组对低密度脂蛋白、载脂蛋白B水平的影响大于缬沙坦组（P〈0．01）。苯那普利组及联合治疗组血清血管紧张素Ⅱ水平均较治疗前显著降低（P〈0．05），而缬沙坦组血清血管紧张素Ⅱ水平较治疗前上升（P〈0．05）。血清白细胞介素1和C反应蛋白水平均较治疗前下降（P〈0．05）。治疗后各组蛋白尿均降低（P〈0．05），联合治疗治疗组降低蛋白尿疗效优于苯那普利组及缬沙坦组（P〈0．05），苯那普利组与缬沙坦组之间差别无统计学意义。结论血管紧张素阻断剂可改善慢性肾脏疾病患者脂质代谢紊乱，下调血清血管紧张素Ⅱ、白细胞介素1及C反应蛋白的表达，降低尿蛋白，联合治疗用药疗效更佳。Aim To investigate the effect of angiotensin system blockers on the levels of serum angiotensin Ⅱ （Ang Ⅱ）, interleukin-1 （IL-1）, C-reaction protein （CRP） andlipid metabolism in patient with chronic glomerular disease. Methods 89 cases of chronic glomerular disease were randomly divided into 3 groups： benazepril group （n = 30）, valsartan group （ n = 30） and combination of benazepril and valsartan group （ n = 29 ）. Serum Ang Ⅱ, IL- 1, CRP, quantity of 24 hour urinary protein and lipid were measured before and after 8 - 12 weeks therapy. Results Serum total cholesterol were effectively decreased in 3 groups after therapy. Combination of benazepril and valsartan therapy reduced triglyceride effectively. Benazepril group and combination of benazepril and valsartan group have more influence on the low density lipoprotein （LDL）, apolipoprotein B than valsartan group （ P 〈 0.01）. Meanwhile the levels of serum Ang Ⅱ was effectively decreased in benazepril group and combination of benazepril and valsartan group （ P 〈 0.05 ）, in contrast to valsartan group, the level of serum Ang Ⅱ was increased （P 〈 0.05 ）. The levels of serum IL- 1 and CRP were significantly reduced after therapy （P 〈 0.05）. Therapeutic alliance group decreased proteinuria more effectively than that of benazepril alone or valsartan alone （ P 〈 0. 05 ）. Conclusions The combination of benazepril and valsartan may reduce the level of serum Ang Ⅱ , IL-1 and CRP, decrease urine protein excretion and ameliorate lipid metabolism in patients with chronic glomerular disease.

关 键 词：内科学 苯那普利 缬沙坦 脂质代谢 血管紧张素Ⅱ 白细胞介素1 C反应蛋白 

分 类 号：R5[医药卫生—内科学]