Hasslacher C, Bostedt-Kiesel A, Kempe H P
Medizinische Universitätsklinik Heidelberg.
Klin Wochenschr. 1992;69 Suppl 29:39-44.
Metabolism of proteins which compose capillary basement membrane is altered in diabetic patients. In the kidney, this leads to an impaired permselectivity of glomerular basement membrane and consequently to onset of proteinuria. Proteinuria which is often increased by hemodynamic factors, initiates and promotes the development of diabetic glomerusclerosis. Aside from near-normal metabolic control, special antihypertensive treatment can reduce proteinuria and retard loss of kidney function in proteinuric diabetic patients. The beneficial effect of ACE-inhibitors on course of diabetic nephropathy is generally thought to be a consequence of decreased systemic and intraglomerular pressure. However, recent longterm studies in Type I and Type II diabetic patients with nephropathy showed that ACE-inhibition can reduce proteinuria independent from their hemodynamic effects and, thus, improves the filtration properties of glomerular basement membrane. This may be due to an influence of ACE-inhibition on metabolism of basement membrane proteins.
糖尿病患者体内构成毛细血管基底膜的蛋白质代谢发生改变。在肾脏中，这会导致肾小球基底膜的通透选择性受损，进而引发蛋白尿。通常由血流动力学因素导致增加的蛋白尿，会引发并促进糖尿病肾小球硬化的发展。除了接近正常的代谢控制外，特殊的抗高血压治疗可以减少蛋白尿，并延缓蛋白尿性糖尿病患者肾功能的丧失。一般认为，ACE抑制剂对糖尿病肾病病程的有益作用是全身和肾小球内压力降低的结果。然而，最近对I型和II型糖尿病肾病患者的长期研究表明，ACE抑制作用可独立于其血流动力学效应而降低蛋白尿，从而改善肾小球基底膜的滤过特性。这可能是由于ACE抑制作用对基底膜蛋白代谢的影响。
