血管紧张素转换酶抑制剂赖诺普利与血管紧张素II受体拮抗剂氯沙坦对特发性膜性肾病合并肾病综合征患者影响的比较

Comparison of the influence of angiotensin-converting enzyme inhibitor lisinopril and angiotensin II receptor antagonist losartan in patients with idiopathic membranous nephropathy and nephrotic syndrome.

作者信息

Kosmadakis George, Filiopoulos Vasileios, Georgoulias Christodoulos, Tentolouris Nicolaos, Michail Spiridon

机构信息

Department of Nephrology Gregorios Vosnides, Laiko Hospital, Athens, Greece.

出版信息

Scand J Urol Nephrol. 2010 Sep;44(4):251-6. doi: 10.3109/00365591003667351.

DOI:10.3109/00365591003667351

PMID:20201749

Abstract

OBJECTIVE

In this prospective study, the effects of an angiotensin-converting enzyme inhibitor [lisinopril (LIS)] and an angiotensin II receptor antagonist [losartan (LOS)] were compared in nephrotic patients with idiopathic membranous nephropathy.

MATERIAL AND METHODS

Twenty-seven patients (13 males, mean age +/- SD 51.3 +/- 15.4 years) were treated with LIS (13 patients, six males, mean age 52.1 +/- 15.3 years) or LOS (14 patients, seven males, mean age 50.5 +/- 15.5 years) for 12 months. At baseline and after the treatment period, serum albumin, total cholesterol, estimated glomerular filtration rate (GFR), 24 h proteinuria and mean arterial pressure were determined.

RESULTS

Proteinuria (g/24 h) was significantly reduced in both groups (LIS from 4.82 +/- 1.26 to 1.75 +/- 0.64, p < 0.0001; LOS from 4.55 +/- 1.09 to 2.54 +/- 1.94, p = 0.002) (all results +/- SD). Serum albumin levels (g/dl) increased significantly in both groups (LIS 2.27 +/- 0.41 to 3.17 +/- 0.63, p < 0.0001; LOS 2.93 +/- 0.40 to 3.55 +/- 0.44, p < 0.0001). GFR (ml/min x 1.73 m(2)) did not change significantly in either group (LIS 55 +/- 17 to 56 +/- 17, p = 0.65; LOS 64 +/- 18 to 59 +/- 16, p = 0.13). Total cholesterol (mg/dl) was significantly reduced only in the lisinopril group (LIS 347 +/- 81 to 266 +/- 64, p < 0.0001; LOS 306 +/- 58 to 263 +/- 77, p = 0.138). Mean arterial pressure (mmHg) was reduced in both groups (LIS 107 +/- 12 to 95 +/- 6, p < 0.0001; LOS 104 +/- 10 to 96 +/- 5, p = 0.003). In the comparison between the two groups, serum albumin levels were higher in the losartan group at baseline (p < 0.0001) and after 12 months (p = 0.029). There were no significant differences between the baseline and end-of-study values for the rest of the studied parameters.

CONCLUSION

Treatment with lisinopril and losartan in nephrotic patients with idiopathic membranous nephropathy results in similar (and significant) effects on renal function, hypoalbuminaemia, proteinuria and blood pressure.

摘要

目的

在这项前瞻性研究中，比较了血管紧张素转换酶抑制剂[赖诺普利（LIS）]和血管紧张素II受体拮抗剂[氯沙坦（LOS）]对特发性膜性肾病肾病患者的影响。

材料与方法

27例患者（13例男性，平均年龄±标准差51.3±15.4岁）接受LIS治疗（13例患者，6例男性，平均年龄52.1±15.3岁）或LOS治疗（14例患者，7例男性，平均年龄50.5±15.5岁），为期12个月。在基线期和治疗期结束后，测定血清白蛋白、总胆固醇、估计肾小球滤过率（GFR）、24小时蛋白尿和平均动脉压。

结果

两组蛋白尿（g/24小时）均显著降低（LIS从4.82±1.26降至1.75±0.64，p<0.0001；LOS从4.55±1.09降至2.54±1.94，p = 0.002）（所有结果±标准差）。两组血清白蛋白水平（g/dl）均显著升高（LIS从2.27±0.41升至3.17±0.63，p<0.0001；LOS从2.93±0.40升至3.55±0.44，p<0.0001）。两组GFR（ml/min×1.73 m²）均无显著变化（LIS从55±17升至56±17，p = 0.65；LOS从64±18降至59±16，p = 0.13）。仅赖诺普利组总胆固醇（mg/dl）显著降低（LIS从347±81降至266±64，p<0.0001；LOS从306±58降至263±77，p = 0.138）。两组平均动脉压（mmHg）均降低（LIS从107±12降至95±6，p<0.0001；LOS从104±10降至96±5，p = 0.003）。两组比较，氯沙坦组基线期（p<0.0001）和12个月后（p = 0.029）血清白蛋白水平较高。其余研究参数的基线值和研究结束时的值之间无显著差异。