Lubrano Riccardo, Soscia Francesca, Elli Marco, Ventriglia Flavia, Raggi Claudia, Travasso Elisabetta, Scateni Simona, Di Maio Valeria, Versacci Paolo, Masciangelo Raffaele, Romero Stefano
Department of Pediatrics, University of Rome La Sapienza, Rome, Italy.
Pediatrics. 2006 Sep;118(3):e833-8. doi: 10.1542/peds.2005-2053. Epub 2006 Aug 21.
We investigated whether the combination of an angiotensin-converting enzyme inhibitor and an angiotensin II type 1 receptor antagonist offers better control of proteinuria and cardiovascular parameters without causing adverse side effects.
We enrolled 10 children (mean age: 12.3 +/- 4.06 years) with proteinuria resulting from chronic renal diseases of various causes. The study consisted of 2 phases, 3 months each, for an overall 6-month observation time. During phase 1 (3 months), each child was assigned randomly to treatment with either an angiotensin-converting enzyme inhibitor or an angiotensin II type 1 receptor antagonist alone. During phase 2, each child was advanced to combination therapy with the addition of an angiotensin II type 1 receptor antagonist or an angiotensin-converting enzyme inhibitor, respectively. Renal function tests, echocardiography, and 24-hour ambulatory blood pressure monitoring were performed at the beginning of the study (time 0), at 3 months (time 1), and at 6 months (time 2).
At time 2, proteinuria (change: -80.21 +/- 10.75%), interventricular septum index (change: -13.63 +/- 18.64%), posterior wall of the left ventricle index (change: -30.71 +/- 20.32%), and left ventricular mass index (change: -28.33 +/- 24.44%) were reduced significantly, compared with time 0 and time 1. No untoward side effects were detected during the study.
In the short term, the combination of angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists for children with proteinuria of renal origin reduced proteinuria significantly, compared with baseline or either drug alone. Furthermore, echocardiographic studies gave evidence of reduction of left ventricular hypertrophy. Additional studies are needed to evaluate long-term results.
我们研究血管紧张素转换酶抑制剂与血管紧张素II 1型受体拮抗剂联合使用是否能更好地控制蛋白尿和心血管参数，且不引起不良反应。
我们纳入了10名因各种原因导致慢性肾病而出现蛋白尿的儿童（平均年龄：12.3±4.06岁）。该研究包括两个阶段，每个阶段3个月，总观察时间为6个月。在第1阶段（3个月），每个儿童被随机分配单独使用血管紧张素转换酶抑制剂或血管紧张素II 1型受体拮抗剂进行治疗。在第2阶段，每个儿童分别加用血管紧张素II 1型受体拮抗剂或血管紧张素转换酶抑制剂，进阶为联合治疗。在研究开始时（时间0）、3个月时（时间1）和6个月时（时间2）进行肾功能测试、超声心动图检查和24小时动态血压监测。
与时间0和时间1相比，在时间2时，蛋白尿（变化：-80.21±10.75%）、室间隔指数（变化：-13.63±18.64%）、左心室后壁指数（变化：-30.71±20.32%）和左心室质量指数（变化：-28.33±24.44%）均显著降低。在研究期间未检测到不良副作用。
短期内，对于肾源性蛋白尿儿童，血管紧张素转换酶抑制剂与血管紧张素II 1型受体拮抗剂联合使用与基线或单独使用任一药物相比，能显著降低蛋白尿。此外，超声心动图研究证明左心室肥厚有所减轻。需要进一步研究来评估长期结果。
