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目的 :分析、探讨影响血管紧张素转化酶抑制剂 (ACEI)抗尿蛋白作用的因素。方法 :原发性肾小球疾病患者 13 6例。分别实施卡托普利、西拉普利和依那普利各两个剂量组治疗 4个月。治疗前及治疗后每月检测平均动脉压 (MAP)、尿蛋白、尿白蛋白排泄率 (UAER)、尿钠和肾功能 ,并检测患者ACE基因表型。依据尿蛋白减少率 (UPDR )分为 :显效组 (UPDR >50 % ) 3 3例 ,良效组 (UPDR :3 0 %～ 50 % ) 49例 ,有效组 (UPDR :10 %～ 3 0 % ) 2 3例 ,无效组 (UPDR :-10 %～ 10 % ) 2 1例 ,恶化组 (UPDR <-10 % ) 10例。分析各组间ACEI种类、剂量以及上述各检测指标的变化。结果 :1.ACEI的抗尿蛋白作用 ,与ACEI种类、剂量和患者ACE基因多态性无关 ;2 .与其他组相比 ,显效组患者治疗前肾功能良好、MAP较低 ;3 .无效组和恶化组治疗过程中食盐摄入控制不良。结论 :ACEI种类、剂量和患者ACE基因多态性不影响ACEI的抗尿蛋白作用 ,肾脏疾病早期应用以及严格限制食盐摄入可提高ACEI抗尿蛋白疗效。
Objective: To analyze and discuss the factors influencing the anti-urinary protein of angiotensin-converting enzyme inhibitor (ACEI). Methods: Thirteen patients with primary glomerular disease were included. Each of the two dose groups, captopril, cilazapril and enalapril, was treated for 4 months. Mean arterial pressure (MAP), urinary protein, urinary albumin excretion rate (UAER), urinary sodium and renal function were measured before and after treatment, and ACE gene phenotype was detected. According to the urinary protein reduction rate (UPDR), there were 49 cases in the effective group (UPDR: 50%), 49 cases in the good group (UPDR: 30% to 50% ), 21 cases in the invalid group (UPDR: -10% ~ 10%) and 10 cases in the worsening group (UPDR <-10%). Analysis of the type of ACEI among the groups, the dose and the above test indicators change. ACE1 anti-urinary protein function, and ACEI type, dose and ACE gene polymorphism in patients has nothing to do; 2. Compared with other groups, the effective group before treatment, renal function is good, MAP is low; 3.Invalid group And deteriorating group poor salt intake control during treatment. CONCLUSION: ACEI type, dose and ACE gene polymorphism do not affect the anti-urinary protein function of ACEI. Early application of renal disease and strict restriction of salt intake can improve the anti-urinary protein efficacy of ACEI.