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目的探讨血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体拮抗剂(ARB)联合治疗在难治性狼疮性肾炎维持性治疗中的作用。方法9例Ⅳ型或Ⅴ型的难治性狼疮性肾炎(有感染合并症或并发症)在诱导治疗2～4个月后仍大量蛋白尿的患者予以ACEI(洛汀新或蒙诺10～20mg/d)和ARB(代文80～160mg/d或科素压50～100mg/d)联合治疗。结果经过诱导治疗,9例患者中无一例完全缓解(CR),4例部分缓解(PR),无效(NR)4例,24h尿蛋白仍>3.5g(除1例外),但低补体血症纠正,2例ANA转阴、5例Ads-DNA阴性,感染治愈。经过ACEI和ARB联合治疗,6个月时CR者2例、PR者7例,有效率100%。泼尼松的用量从(32.5±4.6)mg/d减量为(15.0±2.5)mg/d,两者比较P<0.05。结论ACEI和ARB联合治疗是狼疮性肾炎维持性阶段治疗较为可行的方案,明显提高缓解率,减少激素用量。
Objective To investigate the role of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin Ⅱ receptor antagonist (ARB) in the maintenance of refractory lupus nephritis. Methods Nine patients with type Ⅳ or Ⅴ refractory lupus nephritis (with infection complications or complications) were treated with ACEI (Lotensin or Mono 10 ~ 20mg / d) and ARB (on behalf of 80 ~ 160mg / d or divin pressure 50 ~ 100mg / d) combination therapy. Results After induction therapy, none of the 9 patients had complete remission (CR), 4 patients had partial remission (PR) and 4 patients had no response (NR), and the proteinuria in 24h was still> 3.5g (except 1 patient) Correct, 2 cases of ANA negative, 5 cases of Ads-DNA negative, infection cured. After ACEI and ARB combined treatment, CR 6 cases at 6 months, PR in 7 cases, the effective rate of 100%. The dosage of prednisone was reduced from (32.5 ± 4.6) mg / d to (15.0 ± 2.5) mg / d, P <0.05. Conclusion Combination of ACEI and ARB is a more feasible treatment for lupus nephritis in the maintenance phase, which obviously improves the remission rate and reduces the dosage of hormone.