Renke Marcin, Tylicki Leszek, Rutkowski Przemyslaw, Rutkowski Boleslaw
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.
Scand J Urol Nephrol. 2004;38(5):427-33. doi: 10.1080/00365590410015687.
The renin-angiotensin system is thought to be involved in the progression of chronic renal diseases of both diabetic and non-diabetic origin. It has been confirmed that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) reduce urinary protein excretion and attenuate the development of renal injury. Clinical data comparing the renal effects of ACEIs and ARBs, either singly or in combination, are scarce and usually concern the use of standard or high doses.
This was a prospective, randomized, 9-month study of the effects of low doses of losartan (25 mg; n = 18) versus enalapril (10 mg; n = 18) versus the combination of losartan (25 mg) and enalapril (10 mg) (n = 16) on proteinuria, kidney function and metabolic profile in 54 patients with biopsy-proven chronic glomerulonephritis, hypertension and normal or slightly impaired kidney function. The clinical evaluation and laboratory tests were performed before treatment (baseline) and after 3 and 9 months of therapy.
After 3 months, significant decreases in proteinuria were observed in all groups: losartan, 22.6% (p = 0.02); enalapril, 43% (p = 0.012); and combined therapy, 63% (p = 0.001). This anti-proteinuric effect was even greater after 9 months of therapy: losartan, 44.2% (p = 0.02); enalapril, 49.6% (p = 0.02); and combined therapy, 51% (p = 0.003). There was no significant difference between losartan and enalapril with respect to their impact on proteinuria level. Proteinuria reduction was significantly greater in patients receiving combined therapy in comparison with losartan treatment after 3 months of therapy (p = 0.02). Creatinine clearance and serum creatinine were stable during the entire study period in all patients. No significant changes in lipids, serum uric acid or protein levels were observed.
These results indicate that proteinuria is reduced by low doses of losartan or enalapril. The combination of these drugs seems to be beneficial and may offer an additional renoprotective effect. This needs to be confirmed in a study with a larger sample size.
肾素-血管紧张素系统被认为参与糖尿病和非糖尿病源性慢性肾脏疾病的进展。已证实血管紧张素转换酶抑制剂（ACEIs）和血管紧张素II受体阻滞剂（ARBs）可减少尿蛋白排泄并减轻肾损伤的发展。比较ACEIs和ARBs单独或联合使用的肾脏效应的临床数据很少，且通常涉及标准剂量或高剂量的使用。
这是一项前瞻性、随机、为期9个月的研究，比较低剂量氯沙坦（25毫克；n = 18）、依那普利（10毫克；n = 18）以及氯沙坦（25毫克）与依那普利（10毫克）联合使用（n = 16）对54例经活检证实为慢性肾小球肾炎、高血压且肾功能正常或轻度受损患者的蛋白尿、肾功能和代谢谱的影响。在治疗前（基线）以及治疗3个月和9个月后进行临床评估和实验室检查。
3个月后，所有组的蛋白尿均显著降低：氯沙坦组降低22.6%（p = 0.02）；依那普利组降低43%（p = 0.012）；联合治疗组降低63%（p = 0.001）。治疗9个月后，这种抗蛋白尿作用更为明显：氯沙坦组为44.2%（p = 0.02）；依那普利组为49.6%（p = 0.02）；联合治疗组为51%（p = 0.003）。氯沙坦和依那普利对蛋白尿水平的影响无显著差异。治疗3个月后，联合治疗组患者的蛋白尿降低幅度显著大于氯沙坦治疗组（p = 0.02）。在整个研究期间，所有患者的肌酐清除率和血清肌酐均保持稳定。未观察到血脂、血清尿酸或蛋白质水平有显著变化。
这些结果表明，低剂量的氯沙坦或依那普利可降低蛋白尿。这两种药物联合使用似乎有益，可能具有额外的肾脏保护作用。这需要在更大样本量的研究中得到证实。
