论文部分内容阅读
目的研究血管紧张素转化酶抑制剂(ACEI)类药物福辛普利对慢性肾脏病(CKD)患儿的肾脏保护作用和疗效。方法选择2008年2月-2009年8月在本院住院确诊为激素耐药型肾病综合征(SRNS)及IgA肾病(IgAN)的患儿,随机将其分为中剂量组、低剂量组及对照组。以前瞻性研究方式记录患儿的临床资料,观察24周,定期监测其24 h尿蛋白定量(DPL)、血钾、血肌酐(SCr)、肌酐清除率(CCr)、尿β2-微球蛋白(β2-MG)、血清TGF-β1及血脂、肝功能和血常规等指标,对上述3组指标进行统计学分析。结果治疗后,2个治疗组DPL、平均动脉压、总胆固醇、三酰甘油及尿β2-MG较治疗前明显降低(Pa<0.05),中剂量组血清TGF-β1治疗后显著降低(P<0.05);治疗终点2个治疗组与对照组比较DPL、平均动脉压、尿β2-MG及血清TGF-β1均有统计学差异(Pa<0.05);但仅有中剂量组血清TGF-β1明显低于对照组。中剂量组尿蛋白第12周显著降低(P<0.05),24周转阴率78.26%;低剂量组第20周尿蛋白明显减轻(P<0.05),24周蛋白尿转阴率为42.11%,2组转阴率比较差异有统计学意义(P<0.05)。2个治疗组中高血压患儿治疗后平均动脉压[(72.40±6.10)mmHg,1 mmHg=0.133 kPa]较治疗前[(79.62±6.49)mmHg]显著下降(P<0.05),血压正常者则治疗前后无明显变化(P>0.05);但2组治疗前后尿蛋白下降显著,差异有统计学意义(Pa<0.05)。2个治疗组尿蛋白降低与血压下降无直线相关关系。结论福辛普利有独立降低尿蛋白效应,协同激素和其他免疫抑制剂能有效减轻CKD患儿尿蛋白;福辛普利能通过降低或阻断TGF-β1水平起到延缓肾脏病变进展保护肾脏的作用且有较好的耐受性。
Objective To investigate the renal protective effect and efficacy of fosinopril, an angiotensin converting enzyme inhibitor (ACEI), on children with chronic kidney disease (CKD). Methods From February 2008 to August 2009 in our hospital diagnosed as steroid resistant nephrotic syndrome (SRNS) and IgA nephropathy (IgAN) in children were randomly divided into medium dose group, low dose group and Control group. The clinical data of children were recorded by prospective study. After 24 weeks, the 24-hour urinary protein (DPL), serum potassium, serum creatinine (SCr), creatinine clearance (CCr), urinary β2-microglobulin (β2-MG), serum TGF-β1 and serum lipids, liver function and blood routine. The above three groups of indicators were statistically analyzed. Results After treatment, DPL, mean arterial pressure, total cholesterol, triglyceride and urinary β2-MG in the two treatment groups were significantly lower than those before treatment (P <0.05), while those in the middle-dose group were significantly decreased after treatment with TGF- 0.05). At the end of treatment, DPL, mean arterial pressure, urinary β2-MG and serum TGF-β1 were significantly different between the two treatment groups and the control group (Pa0.05) Lower than the control group. The urinary protein in the middle-dose group was significantly lower at 12 weeks (P <0.05), and the negative rate at 24 weeks was 78.26%. The proteinuria in the low-dose group was significantly reduced at the 20th week (P <0.05) There was significant difference between the two groups (P <0.05). Mean arterial pressure (72.40 ± 6.10) mmHg, 1 mmHg = 0.133 kPa in children with hypertension after treatment in two treatment groups was significantly lower than that before treatment [(79.62 ± 6.49) mmHg] (P <0.05) There was no significant change before and after treatment (P> 0.05). However, the urinary protein decreased significantly in both groups before and after treatment (P <0.05). There was no linear correlation between the reduction of urinary protein and blood pressure in the two treatment groups. Conclusion Fosinopril can independently reduce urinary protein, synergistic hormones and other immunosuppressive agents can effectively reduce urinary protein in children with CKD; fosinopril can reduce or block the level of TGF-β1 can delay the progression of renal disease protect the kidneys The role and have better tolerance.