201412氯沙坦修改..docVIP

氯沙坦对特发性膜性肾病患者尿蛋白谱的影响 潘靖年 王翔 武文斌1 【摘要】目的 观察氯沙坦对特发性膜性肾病（idiopathic membranous nephropathy IMN）患者尿蛋白谱的影响,以期阐明其部分治疗机理。方法 对42例IMN患者服用氯沙坦（100mg/d）3个月，治疗前后分别进行尿β2-微球蛋白肌酐比值(β2-MG/Cr)、视黄醇结合蛋白肌酐比值(RBP/Cr)、蛋白肌酐比值(PRO/Cr), 足细胞顶端膜性蛋白Podocalyxin肌酐比值(PCX/Cr)、白蛋白肌酐比值 (ALB/Cr)、免疫球蛋白G肌酐比值(IgG/Cr)测定，然后对治疗前后结果进行分析评价。结果 氯沙坦治疗后尿PCX/Cr、 ALB/Cr较治疗前有明显降低(P＜0.01)；尿PRO/Cr治疗后有所下降(P＜0.05)，但尿β2-MG/Cr RBP/Cr、IgG/Cr治疗前后比较无差异（P0.05）。结论 氯沙坦可明显减少IMN患者尿蛋白排泄，其机理可能与肾小球基底膜电荷屏障的修复有关，对肾小球基底膜的结构损伤无修复作用，也未发现对损伤肾小管明显的保护作用。 【关键词】特发性膜性肾病；氯沙坦；尿蛋白谱 Effect of losartan on urinary protein spectrum in patients with idiopathic membranous nephropathy PAN Jing-nian，WANG Xiang, WU Wen-bin. Yidu Central Hospital of Weifang, Qingzhou 262500, China 【Abstract】Objective To observe the effect of losartan on urinary protein spectrum in patients with idiopathic membranous nephropathy(IMN) to clarify partial therapeutic mechanism. Mathods Give 42 patients with idiopathic membranous nephropathy losartan to treat for 3 months（100mg daily）.To detect the urinary β2-microglobulin(β2-MG),the urinary retinol binding protein(RBP),the urinary protein creatinine ratio(PCR), the urinary podocyte apical membrane protein (PCX),the urinary Albumin creatinine ratio(ACR）,Immunoglobulin G (IgG) before and after 3 months treatment，then analyze and evaluate the results.Results After treatment of losartan, PCX（P0.01），ACR（P0.01）and PCR(P0.05) were decreased. there were no significant difference in β2-MG，RBP and IgG (P0.05). Conclusions Losartan had a protective effect on charge barrier in patients with idiopathic membranous nephropathy, thus effectively reducing urinary protein excretion, but had no effects on glomerular basement membrane structural damage and renal tubular injury. 【Key words】idiopathic membranous nephropathy;losartan; urinary protein spectrum 膜性肾病(membranous nephropathy，MN)约占原发性肾病综合征(nephrotic syndrome，NS)的20%～35%，是NS常见的病理类型之一。特发性膜性肾病（idiopathic membranous nephropathy，IMN）是导致成人肾病综合征的一个常见病因,以肾小球基底膜弥漫性增厚，其上皮下免疫复合物沉积致足细胞功能