螺内酯治疗慢性镉接触肾损害的临床观察  

Clinical observation of spironolactone treatment for kidney damage due to chronic cadmium exposure

作　　者：容开萍 李巍 甘福生 梁小滨 付忠 

机构地区：[1]江西省职业病防治研究院,江西省职业病医院,南昌330006 [2]江西中医学院第二附属医院,南昌330012 [3]江西省机场集团急救中心,南昌330114

出　　处：《江西医药》2016年第12期1316-1318,1343,共4页Jiangxi Medical Journal

基　　金：江西省卫生计生委科技计划项目(编号:20156045)

摘　　要：目的探讨醛固酮拮抗剂(螺内酯)对慢性镉接触肾损害的治疗作用。方法选取本院2012年3月-2016年1月因慢性镉接触住院病人,2012年3月-2015年12月期间31例患者采用传统治疗方案(对照组),2016年1月17例患者在对照组基础上加服螺内酯20mg/d(治疗组),两组病人于入院时及治疗2周后分别检测尿镉、尿β_2-微球蛋白、尿肌酐等进行统计分析。结果治疗前后的尿镉差值(对照组与治疗组秩均值分别为24.13;25.18)、校正尿镉的差值(对照组与治疗组秩均值分别为27.03;19.88)、校正尿β_2-微球蛋白的差值(对照组与治疗组秩均值分别为26.9;20.12)、尿肌酐的差值(对照组与治疗组秩均值分别为23.21;26.85),对照组与治疗组间差异无统计学意义(P>0.05);而治疗前后尿β_2-微球蛋白的差值(对照组与治疗组秩均值分别为28.42;17.35),对照组与治疗组间差异有统计学意义(P<0.01)。结论尿β_2-微球蛋白作为慢性镉接触肾损害的靶效应指标,短期醛固酮拮抗剂(螺内酯)治疗慢性镉接触可以有效减低尿β_2-微球蛋白。醛固酮拮抗剂对保护因慢性镉接触致肾损害有临床意义。Objective To investigate effects of aldosterone antagonist（spironolactone） treatment for kidney damage cause by chronic cadmium exposure. Methods Forty-eight patients,in Mar. 2012-Jan. 2016 due to chronic cadmium exposure were enrolled in study. During the period from March 2012 to December 2015,thirty-one patients were treated with conventional treatment（control group）. In Jan. 2016,seventeen patients were treated with conventional and plus service spironolactone 20 mg once daily（treatment group）. Two groups of patients at admission and after treatment for 2 weeks,respectively,the detection of urinary cadmium,urine β_2- microglobulin,urine creatinine,and statistical analysis. Results Between of before and after treatment,the difference of urinary cadmium（The mean rank of the control group and treatment group respectively was 24.13 and 25.18）,the difference of the corrected urinary cadmium（The mean rank of the control group and treatment group respectively was 27.03 and 19.88）,the difference of the corrected urinary β_2- microglobulin（The mean rank of the control group and treatment group respectively was 26.9 and 20.12）,the difference of urinary creatinine（The mean rank of the control group and treatment group respectively was 23.21 and 26.85）,was no statistically significant difference between control group and the treatment group（P0.05）. The difference of urinary β_2- microglobulin between before and after treatment（The mean rank of the control group and treatment group respectively was 26.9 and 20.12）,has a statistically significant difference among the control group and the treatment group（P0.01）. Conclusion Urinary β_2- microglobulin as chronic cadmium exposure indicators of renal damage target effects,short-term aldosterone antagonist（spironolactone） treatment of chronic cadmium exposure can effectively reduce urinary β_2- microglobulin. Aldosterone antagonists have clinical significance in the protection of renal damage caused by chronic cadmium exposure.

关 键 词：醛固酮拮抗剂 镉 肾损害 尿Β2-微球蛋白 

分 类 号：R135.1[医药卫生—劳动卫生]