Gottlieb S S, Robinson S, Weir M R, Fisher M L, Krichten C M
Department of Medicine, University of Maryland School of Medicine, Baltimore 21201.
Am Heart J. 1992 Jul;124(1):131-6. doi: 10.1016/0002-8703(92)90930-t.
The objective of the present study was to determine whether pretreatment neurohormonal and renal hemodynamic parameters predict the change in renal function with the administration of quinapril, a new angiotensin-converting enzyme (ACE) inhibitor. Twenty patients with New York Heart Association (NYHA) class III and IV heart failure were evaluated. Following pretreatment determination of renal function and plasma neurohormones, patients were treated daily with 10 mg of quinapril. Measurements of glomerular filtration rate (GFR) and renal plasma flow (RPF) were repeated after 7 weeks to assess changes in function (delta GFR and delta RPF). Mean GFR increased from 49 +/- 6 to 56 +/- 7 ml/min/1.73 m2 (p = 0.10), but decreased in five patients. Mean RPF increased from 235 +/- 23 to 252 +/- 23 ml/min/1.73 m2 (p = 0.08), but decreased in five patients. There was no relation between delta GFR and baseline determinations of GFR, RPF, plasma renin activity, plasma angiotensin II, or serum Na. Only a high filtration fraction (GFR/RPF) predicted a decreased GFR (r = 0.61, p less than 0.005). In contrast, no baseline renal hemodynamic parameter correlated with delta RPF. We conclude that poor renal function does not increase the risk of renal deterioration with quinapril. However, dependence of renal function upon the renin-angiotensin system may be predicted by a high filtration fraction.
本研究的目的是确定治疗前的神经激素和肾血流动力学参数是否能预测新型血管紧张素转换酶（ACE）抑制剂喹那普利给药后肾功能的变化。对20例纽约心脏协会（NYHA）III级和IV级心力衰竭患者进行了评估。在治疗前测定肾功能和血浆神经激素后，患者每日服用10 mg喹那普利。7周后重复测量肾小球滤过率（GFR）和肾血浆流量（RPF），以评估功能变化（ΔGFR和ΔRPF）。平均GFR从49±6增加至56±7 ml/min/1.73 m²（p = 0.10），但有5例患者GFR下降。平均RPF从235±23增加至252±23 ml/min/1.73 m²（p = 0.08），但有5例患者RPF下降。ΔGFR与GFR、RPF、血浆肾素活性、血浆血管紧张素II或血清钠的基线测定值之间无相关性。只有高滤过分数（GFR/RPF）可预测GFR降低（r = 0.61，p < 0.005）。相比之下，没有基线肾血流动力学参数与ΔRPF相关。我们得出结论，肾功能不佳并不会增加喹那普利导致肾恶化的风险。然而，高滤过分数可能预示着肾功能对肾素-血管紧张素系统的依赖性。
