双重RAS阻断与单药治疗在非老年CKD1-3a期糖尿病肾病的疗效及安全性比较分析  

Comparative analysis of the efficacy and safety of dual blockade of the RAS and monotherapy in the non-elderly patients with CKD1-3a complicated with diabetic nephropathy

作　　者：梅玫 方利 赵贵盛 张倩 赵洪雯 申兵冰 MEI Mei;FANG Li;ZHAO Guisheng;ZHANG Qian;ZHAO Hongwen;SHEN Bingbing(Department of Nephrology,the First Affiliated Hospital of ARMY Medical University,Chongqing 400038,China;Department of Nephrology,the People′s Hospital of Shapingba District,Chongqing 400030,China;Department of Hemodialysis, Southwest Aluminium Hospital,Chongqing 401326,China)

机构地区：[1]陆军军医大学第一附属医院肾内科,重庆400038 [2]重庆市沙坪坝区人民医院肾内科,400030 [3]重庆市西南铝医院血液透析科,401326

出　　处：《重庆医学》2022年第4期618-623,629,共7页Chongqing medicine

基　　金：重庆市科卫联合医学科研项目(2018MSXM123)。

摘　　要：目的评价双重肾素-血管紧张素系统(RAS)阻断策略与单药优化治疗策略在非老年慢性肾脏病(CKD)1-3a期糖尿病肾病患者中的疗效及安全性。方法采用回顾性研究,从CKD随访管理系统中纳入45例接受双重RAS阻断治疗的非老年(WHO标准:<60岁)CKD1-3a期糖尿病肾病患者(双重RAS阻断组)。随后,采用倾向评分匹配法选择45例单独接受最大可耐受剂量血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)治疗的非老年CKD1-3a期糖尿病肾病的匹配历史对照患者(单药治疗组)。将两组患者的临床数据在基线水平和随访3、6、12个月进行分析比较,并记录不良反应。采用logistic回归分析确定有效蛋白尿减少率的影响因素。结果两组基线资料相当。随访6、12个月,双重RAS阻断组24 h尿蛋白定量水平均明显低于单药治疗组(P<0.05);且随访12个月,双重RAS阻断组24 h尿蛋白定量水平较基线水平下降50%及以上的患者百分比明显高于单药治疗组(77.8%vs.60.0%,P=0.032);两组各时间点估计的肾小球滤过率(eGFR)、平均动脉压比较,差异均无统计学意义(P>0.05);两组均无严重不良反应发生。多因素logistic回归分析发现,双重RAS阻断[OR=2.97,95%CI(1.99,3.88)]是有效蛋白尿减少率(≥50%)的独立影响因素。结论非老年CKD1-3a期的糖尿病肾病患者使用双重RAS阻断策略较单药治疗更有助于控制蛋白尿,且并不增加不良反应的发生。Objective To evaluate the efficacy and safety of dual blockade of the renin-angiotensin system(RAS)and single-agent optimized treatment strategy in the non-elderly patients with stage 1-3a chronic kidney disease(CKD)complicated with diabetic nephropathy.Methods A retrospective study was performed.A total of 45 non-elderly(WHO criteria:<60 years old)patients with CKD1-3a complicated with diabetic nephropathy received dual RAS blocking therapy(the dual RAS blocking group)were enrolled from the CKD follow-up management system.Subsequently,a total of 45 matched historical control non-elderly patients with CKD1-3a complicated with diabetic nephropathy who received the maximum tolerable dose of angiotensin-converting enzyme inhibitor(ACEI)or angiotensin receptor blocker(ARB)alone(the monotherapy group)were selected by using the propensity score matching method.The clinical data of the two groups were analyzed and compared at baseline and at 3,6 and 12 months follow-up.The adverse reactions were recorded.The logistic regression analysis was used to determine the influencing factors of effective proteinuria reduction rate.Results The baseline data of the two groups was similar.After 6 and 12 months of the follow-up,the quantitative level of 24-hour urinary protein in the dual RAS blocking group was significantly lower than that in the monotherapy group(P<0.05).Additionally,after 12-month follow-up,the percentage of the patients whose 24-hour urinary protein level decreased by 50%or more compared with the baseline level in the double RAS blocking group was significantly higher than that in the monotherapy group(77.8%vs.60.0%,P=0.032).There was no significant difference in the estimated glomerular filtration(eGFR)and mean arterial pressure between the two groups at each time point(P>0.05).No serious adverse reaction was observed in the two groups.Multivariate logistic regression analysis showed that the dual RAS blockade[OR=2.97,95%CI(1.99,3.88)]was an independent influencing factor of the effective reduction rate(≥50%)o

关 键 词：糖尿病肾病 肾素-血管紧张素系统 双重阻断 非老年 疗效 安全性 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]