el-Agroudy Amgad E, Hassan Nabil A, Foda Mohamed A, Ismail Amani M, el-Sawy Essam A, Mousa Omar, Ghoneim Mohamed A
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Am J Nephrol. 2003 Sep-Oct;23(5):300-6. doi: 10.1159/000072820. Epub 2003 Aug 6.
BACKGROUND/AIM: Transforming growth factor-beta1 (TGF-beta 1) is involved in the pathogenesis of chronic allograft nephropathy after kidney transplantation. The aim of the study was to evaluate the effect of the angiotensin receptor blocker losartan on TGF-beta 1 plasma levels and proteinuria in hypertensive transplant recipients.
A total of 162 transplant recipients were included in the study. The patients were randomized into 3 groups: group 1 received losartan; group II received an angiotensin-converting enzyme inhibitor (captopril), and group III received a calcium channel blocker (amlodipine). All the parameters were recorded at the time of therapy initiation and at 1, 4 and 12 weeks and 12 months thereafter. Graft biopsy before the start and at the end of the study was done to evaluate histopathological progression.
Blood pressure was controlled in the 3 groups; however, the need for other antihypertensive agents was significant in groups I and II. Treatment with losartan significantly decreased the plasma level of TGF-beta1, 24-hour urinary protein and serum uric acid (p < 0.05). No significant changes were seen in the hemoglobin or serum potassium levels. The rate of histopathological progression was significantly lower in the losartan group. No patient was discharged from the study due to side effects.
After transplantation all drugs were able to control blood pressure with good safety and tolerability. The study demonstrates that ARB significantly decreases the plasma levels of TGF-beta1, proteinuria and uric acid. These results could play an important and decisive role in the treatment and prevention of chronic allograft nephropathy.
背景/目的：转化生长因子-β1（TGF-β1）参与肾移植后慢性移植肾肾病的发病机制。本研究旨在评估血管紧张素受体阻滞剂氯沙坦对高血压移植受者血浆TGF-β1水平和蛋白尿的影响。
本研究共纳入162例移植受者。患者被随机分为3组：第1组接受氯沙坦治疗；第II组接受血管紧张素转换酶抑制剂（卡托普利）治疗，第III组接受钙通道阻滞剂（氨氯地平）治疗。在治疗开始时、1周、4周、12周以及之后的12个月记录所有参数。在研究开始前和结束时进行移植肾活检以评估组织病理学进展。
3组患者的血压均得到控制；然而，第I组和第II组对其他降压药物的需求显著。氯沙坦治疗显著降低了血浆TGF-β1水平、24小时尿蛋白和血清尿酸水平（p<0.05）。血红蛋白或血清钾水平未见显著变化。氯沙坦组的组织病理学进展率显著较低。没有患者因副作用退出研究。
移植后所有药物均能安全、耐受良好地控制血压。本研究表明，ARB可显著降低血浆TGF-β1水平、蛋白尿和尿酸水平。这些结果可能在慢性移植肾肾病的治疗和预防中发挥重要的决定性作用。
