血管紧张素转换酶抑制剂／血管紧张素Ⅱ受体拮抗剂对维持性腹膜透析患者腹膜透出液蛋白含量的影响  

Effect of ACEI/ARBs on peritoneal protein loss in peritoneal dialysis patients

作　　者：罗富里 杨林[1] 稂春燕 蔡得汉[1] 陈耀辉[1] 刘鸿[1] 刘珍华[1] 李赟[1] 

机构地区：[1]江西省人民医院肾内科江西省肾脏病重点实验室,330006

出　　处：《中华肾脏病杂志》2014年第8期575-579,共5页Chinese Journal of Nephrology

基　　金：赣鄱英才555工程领军人才培养计划项目

摘　　要：目的观察血管紧张素转换酶抑制剂／血管紧张素Ⅱ（ACEI/ARBs）类药物对腹膜透析（PD）患者透出液的蛋白含量的影响。方法回顾性分析81例PD患者的透出液蛋白含量，其中37例患者接受ACEI／ARBs治疗（观察组），44例未接受ACEI／ARBs治疗（对照组）。采用自身对照和组间对照的方法评估ACEI／ARBs治疗对患者透出液蛋白含量的影响；分层分析残余肾功能、透析龄对ACEI／ARBs类药物疗效的影响。结果（1）与治疗前比较，观察组患者ACEUARBs治疗后的透出液蛋白含量减少，中位差值1．2（0，1．6）g/24h，与对照组差值比较差异有统计学意义（P＜0．05）。（2）eGFR＞2ml·min^-1·（1．73m^2）^-1组患者ACEI／ARB治疗后透出液蛋白含量减少，中位差值1．4（1．2，2．3）g/24h，与对照组比较差异有统计学意义（P＜0．001）；eGFR〈2ml·min^-1·f1．73m^2）^-1组患者透出液蛋白含量差值与对照组比较差异无统计学意义。（3）透析龄＜12月组患者ACEI／ARBs治疗后透出液中蛋白含量较治疗前减少，中位差值1．0（0．8，1．4）g/24h，与对照组相比差异有统计学意义（P＜0．05）；透析龄12～24个月和＞24个月组患者透出液蛋白含量差值与对照组相比差异均无统计学意义（P＞0．05）。结论ACEI／ARBs能减少患者腹膜透出液中的蛋白丢失，在残余肾功能较好和透析龄较短的患者中效果更明显。Objective To observe the effect of ACEI/ARBs on peritoneal protein loss in peritoneal dialysis patients. Methods Total of 81 peritoneal dialysis patients were included in the study. Thirty- seven cases were treated with ACEI/ARBs（ACEI/ARBs group）, forty-four cases did not receive any ACEI/ARBs （Control group）. After 6 mouths, the effect of ACEI/ARBs on peritoneal protein loss was evaluated, and the effects of residual renal function and dialysis age on the peritoneal protein loss were statistically analyzed. Results （1） The peritoneal protein loss was reduced in ACEI/ARBs group, the difference was 1.2（0, 1.6） g/24 h, while in the control group, the protein loss had no statistically significant change, the difference between the two group was statistically significant （P〈0.05）. （2） When the patients＇ eGFR〉2 ml·min^-1·（1.73 m^2）^-1, the difference of the protein loss inACEI/ARBs group was 1.4（1.2, 2.3） g/24 h , the difference between the two group was statistically significant（P〈0.01）; when patients＇ eGFR〈2 ml·min^-1. （1.73 m^2）^-1, the differences of the protein loss between the two groups had no significant difference （P〉0.05）. （3） When the dialysis ages 〈12 months , the difference of the protein loss was 1.0（0.8, 1.4） g/24 h in ACEI/ARBs group, the differences between the two groups was statistically significant （P〈0.05）; when the dialysis ages was from 12 months to 24 months or more than 24 months, The differences of the protein loss between the two groups and control group were both not statistically significant （P〉0.05）. Conclusion ACEI/ARBs can reduce peritoneal protein loss in PD patient, the effect was better when patients＇ residual renal function was better or dialysis age was shorter.

关 键 词：腹膜透析 血管紧张素转换酶抑制剂 血管紧张素Ⅱ受体拮抗剂 蛋白质 透析液 丢失 

分 类 号：R459.5[医药卫生—治疗学]