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目的观察血管紧张素系统阻断剂对慢性肾脏疾病患者脂质代谢、血管紧张素Ⅱ、白细胞介素1及C反应蛋白水平的的影响。方法89例伴有蛋白尿的慢性肾小球疾病患者随机分为三组:苯那普利组(n=30)、缬沙坦组(n=30)和联合治疗(苯那普利+缬沙坦)组(n=29),治疗8~12周。分别检测血脂、血管紧张素Ⅱ、白细胞介素1和C反应蛋白水平及24 h尿蛋白定量。结果治疗后各组血清总胆固醇水平显著降低;联合治疗组甘油三酯水平显著降低(P<0.05);苯那普利组和联合治疗组对低密度脂蛋白、载脂蛋白B水平的影响大于缬沙坦组(P<0.01)。苯那普利组及联合治疗组血清血管紧张素Ⅱ水平均较治疗前显著降低(P<0.05),而缬沙坦组血清血管紧张素Ⅱ水平较治疗前上升(P<0.05)。血清白细胞介素1和C反应蛋白水平均较治疗前下降(P<0.05)。治疗后各组蛋白尿均降低(P<0.05),联合治疗治疗组降低蛋白尿疗效优于苯那普利组及缬沙坦组(P<0.05),苯那普利组与缬沙坦组之间差别无统计学意义。结论血管紧张素阻断剂可改善慢性肾脏疾病患者脂质代谢紊乱,下调血清血管紧张素Ⅱ、白细胞介素1及C反应蛋白的表达,降低尿蛋白,联合治疗用药疗效更佳。
Objective To investigate the effects of angiotensin system blockers on the lipid metabolism, the levels of angiotensin Ⅱ, interleukin-1 and C-reactive protein in patients with chronic kidney disease. Methods Eighty-nine patients with chronic glomerular disease associated with proteinuria were randomized into three groups: benazepril (n = 30), valsartan (n = 30) and combination therapy (benazepril + valine Sotalol) (n = 29) for 8 to 12 weeks. Blood lipid, angiotensin Ⅱ, interleukin-1 and C-reactive protein levels and 24 h urinary protein were detected respectively. Results Serum total cholesterol levels decreased significantly in all groups after treatment. Triglyceride levels were significantly lower in combined treatment group (P <0.05). The effects of benazepril and combination therapy on LDL and apolipoprotein B levels were greater than those of combined treatment group Valsartan group (P <0.01). The levels of serum angiotensin Ⅱ in benazepril group and combination group were significantly lower than those before treatment (P <0.05), while the levels of serum angiotensin Ⅱ in valsartan group were higher than those before treatment (P <0.05). Serum interleukin-1 and C-reactive protein levels were lower than before treatment (P <0.05). The albuminuria of all the groups decreased after treatment (P <0.05), and the combination therapy group was better than the benazepril group and the valsartan group (P <0.05). The benazepril group and the valsartan group The difference was not statistically significant. Conclusion Angiotensin blocker can improve lipid metabolism disorder, reduce the expression of serum angiotensin Ⅱ, interleukin - 1 and C - reactive protein, and lower urinary protein in patients with chronic kidney disease. The combination therapy is better.