氯沙坦治疗肾移植后大量蛋白尿  

Treatment of massive proteinuria in kidney transplant recipients by Iosartan

作　　者：龚华[1] 谈呜岳 刘志宏[1] 沈兵[1] 秦燕[1] 祝捷[1] 包尔敦[1] 邱建新[1] 范昱[1] 

机构地区：[1]上海交通大学附属第一人民医院移植泌尿科,200080

出　　处：《中华器官移植杂志》2009年第5期275-277,共3页Chinese Journal of Organ Transplantation

摘　　要：目的探讨氯沙坦对肾移植后大量蛋白尿的治疗作用。方法接受尸体肾移植、术后时间达1年以上、24h尿蛋白定量≥300mg的患者82例，以计算器随机数法分为氯沙坦组和对照组，每组各41例。氯沙坦组患者连续服用氯沙坦达1年以上，剂量为50～100mg／d；对照组患者连续服用氨氯地平达1年以上，剂量为5～10mg／d。观察12个月，记录患者的血压、24h尿蛋白定量、血肌酐等。结果研究过程中，两组患者的血压均有所下降，但下降幅度的差异无统计学意义（P〉0．05）。氯沙坦组研究开始时和研究结束时的24h尿蛋白定量分别为（1．9±1．5）g和（1．1±0．8）g，二者的差异有统计学意义（P〈0．05），而对照组研究开始时和研究结束时24h尿蛋白定量的差异无统计学意义（P〉0．05）。与研究开始时相比较，氯沙坦组中血压控制者及血压未控制者的尿蛋白均有所减少，差异均有统计学意义（P〈0．05，P〈0．05）。对照组中，仅血压控制者的尿蛋白较研究开始时有所减少（P〈0．05），血压未控制者的尿蛋白反而较研究开始时有所增加（P〈0．05）。氯沙坦组和对照组中，治疗明显有效（尿蛋白下降≥50％）者分别占56．4％和15．8％，二者的差异有统计学意义（P〈0．01）。结论氯沙坦对肾移植后大量蛋白尿有一定的治疗作用，且该作用不依赖于患者血压的下降。Objective To analyze the efficacy and safety of losartan in the treatment of massive proteinuria in kidney transplant recipients. Methods All of the 82 patients were randomized in two groups： losartan group and control group （amlodipine group）. Both of the groups were divided into two different subsets according to blood pressure control. Twenty-four-hour proteinuria, serum creatinine, blood pressure and adverse effects were observed. Results Losartan and amlodipine had the similar effects on blood pressure control. The 24-h proteinuria in losartan group at the end of the study was significantly lower than that at the baseline, and there was significant difference between the losartan blood pressure control subset and the losartan blood pressure un-control subset. The effective rate and significant effective rate in losartan group for massive proteinuria were higher than in control group. Conclusion T Losartan can be effectively and safely used for the treatment of massive proteinuria in renal transplant recipients independent of blood pressure.

关 键 词：肾移植 蛋白尿 氯沙坦 

分 类 号：R686[医药卫生—骨科学]