较高剂量缬沙坦及贝那普利对IgA肾病疗效对比.docVIP

较高剂量缬沙坦及贝那普利对IgA肾病疗效对比 　 作者：刘晓渭，王汉民，陈威，李怀平，许国双，刘宏宝，孙世仁，白淑蓉 【摘要】 目的 观察较大剂量的缬沙坦与贝那普利对IgA肾病的疗效和安全性。方法 61例患者随机分为三组：缬沙坦组(对照1组)(n=20)，服用缬沙坦160mg/d，贝那普利组(对照2组)(n=20)服用盐酸贝那普利20mg/d。联合组(治疗组)(n=21)服用缬沙坦160mg/d联合盐酸贝那普利20mg/d，疗程6个月，观察24h尿蛋白定量、血清肌肝、血压及血钾等变化及不良反应情况。结果 6个月时三组24h尿蛋白定量均有明显下降，尤以治疗组明显，与其他两组比较差异显著(Plt;0.05)，总有效率分别为治疗组85.7%，对照1组45.0%，对照2组40.0%，均以治疗组最显著；与其他两组比较差异显著(Plt;0.01)，而对照1组与对照2组比较无明显差异(Pgt;0.05)。三组均能有效降低血压且副作用较轻，三组之间比较无显著性差异(Pgt;0.05)。结论 较大剂量血管紧张素受体拮抗剂联合较大剂量转换酶抑制剂治疗IgA肾病安全有效，其疗效优于单用盐酸贝那普利或单用缬沙坦。 【关键词】 盐酸贝那普利；缬沙坦；IgA肾病；治疗 　　Comparison of therapeutic effect of higherdose valsatan combined　with higher dose of lotensin for IgA nephropathy 　　ABSTRACT: Objective To observe the effect and safety of higherdose valsatan combined with benazepril on patients with IgA nephropathy. Methods Sixtyone patients were assigned to three groups at random. Patients took valsartan 160mg/d in ARB group (n=20), or benazepril hydrochloride 20mg/d in benazepril group (n=20), or valsartan 160mg/d plus benazepril hydrochloride in combined therapy group (n=21) for six months. Urine protein, serum creatine, serum potassium, blood pressure and adverse effects were detected during the trial. Results After six months of therapy, 24hour proteinuria decreased, especially in therapy group (Plt;0.05). The total effective rate was 85.7% in therapy group, 45.0% in first group, and 40.0% in the last one. There was no significant difference in the last two groups. Blood pressure in the three groups were decreased effectively with fewer side effects without obvious differences in the three groups. Conclusion It is safe and effective to treat IgA nephropathy with higher dose of valsatan combined with angiotensin converting enzyme inhibitor. It is superior to benazepril hydrochloride or valsatanalone. 　　KEY WORDS: benazepril hydrochloride; valsatan; IgA nephropathy; treatment 　　IgA肾病(IgA nephropathy)是导致我国肾病患者终末期肾衰竭的常见原因之一。目前，尚缺乏确切有效的治疗手段。研究表明，进展性IgA肾病患者肾脏局部的血管紧张素Ⅱ(angiotensinⅡ)活性增高[1]，血管紧张素受体拮抗剂(angiot