螺内酯对慢性肾脏病患者尿蛋白和尿血管紧张素原的影响  

作　　者：张霞[1] 朱莉[1] 徐晓[1] 陈琨[1] 

机构地区：[1]浙江省金华市中心医院,321000

出　　处：《浙江临床医学》2017年第5期832-833,836,共3页Zhejiang Clinical Medical Journal

摘　　要：目的观察螺内酯降低非糖尿病性慢性肾脏病（CKD）患者尿蛋白和尿血管紧张素原（UAGT）水平的作用及效果。方法2013年10月至2014年7月非糖尿病CKD患者40例。随机分为螺内酯组（n=20）和对照组（n=20）．螺内酯组患者接受螺内酯治疗剂量40mg／d。分别观察患者l、3、6、12个月尿蛋白和UAGT的排泄水平及肾功能的变化。结果对照组患者在随访期间，平均动脉压（MAP）水平无明显变化（P〉0．05），而接受螺内酯治疗12个月后MAP显著降低（P〈0．05）。但两组在治疗期间均达到目标血压值（〈140／90mmHg）。随访6个月后，对照组和螺内酯组血肌酐浓度和估算肾小球滤过率（eGFR）与基线水平差异无统计学意义（P〉0．05）．但在12个月后，对照组中肌酐浓度显著高于基线水平（P〈0．05），eGFR显著低于基线水平（P〈0．05）。螺内酯治疗6个月后，尿蛋白／肌酐（UP／Cr）、UAGT均呈下降趋势，与基线相比较差异有统计学意义（P〈0，05）。螺内酯治疗12个月后，UP／Cr的变化与Log（UAGT／Cr）呈正相关（r=0．447，P=0．048），与MAP（r=0．288，P=0．219）及血AGT浓度（r=0．058，P=0．808）无明显相关性。多元线性回归分析发现，Log（UAGT／Cr）与UP／Cr的变化相关（r=0124，P=0．035）。结论在非糖尿病性慢性肾脏病患者中，螺内酯显著降低尿蛋白和尿血管紧张素原的排泄水平，从而发挥肾脏保护作用。Objective To investigate the effect of spironolactone on reducing the levels of proteinuria and urinary angiotensinogen （ UAGT ） in patients with non-diabetic chronic kidney disease （ CKD ） . Methods 40 patients with non-diabetic CKD hospitalized in Jinhua Central Hospital from October 2013 to July 2014 were selected. The patients were randomly assigned to spironolactone group （ n=20 ） and control group （ n=20 ） . Patients of spironolactone group received treatment with spironolactone dose 40mg/d. Observation time was 12 months, excretion of proteinuria and UAGT and renal function of the patients were observed in 1, 3, 6 and 12 months. Results No significant change in MAP level （ P〉0.05 ） was observed in the control group during the follow-up period. Mean arterial pressure （ MAP ） of patients received spironolactone decreased significantly after 12 months （ P〈0.05 ） . But both of the groups achieved the target blood pressure （ 〈140/90mmHg ） during the treatment period. There were no significantly differences of the blood creatinine, estimated glomerular filtration rate （ eGFR ） and baseline levels between two groups after 6 months follow up （ P〉0.05 ） . But the creatinine in the control group was significantly higher than that of the baseline after 12 months （ P〈0.05 ） , the eGFR was significantly lower than the baseline （ P〈0.05 ） . 6 months after the treatment, UAGT and proteinuria/creatinine （ UP/Cr ） showed a downward trend, the differences had statistical significance （ P〈0.05 ） . The changes of UP/Cr and log （ UAGT/Cr ） were positively correlated 12 months after the spironolactone treatment, （ r=0.447, P=0.048 ） , there was no significant correlation between MAP （ r=-0.288, P=0.219 ） and concentration of blood AGT （ r=-0.058, P=0.808 ） . Multiple linear regression analysis revealed that only Log （ UAGT/Cr ） change was associated with UP/Cr （ r=0.124, P=0.035 ） . Conclusion Spironolactone can protect the renal func

关 键 词：螺内酯 慢性肾脏病 尿蛋白 尿血管紧张素原 

分 类 号：R544.1[医药卫生—心血管疾病]