Kurkus J, Thysell H
Department of Nephrology, University Hospital, Lund, Sweden.
Scand J Urol Nephrol. 1990;24(1):63-8. doi: 10.3109/00365599009180362.
The urinary albumin excretion measured by the albumin creatinine clearance ratio (Calb/Ccreat) and the mean supine arterial blood pressure (MAP) were studied before the start of ACE inhibition, at the start and during up to 1 year of ACE inhibition with Captopril or Enalapril in 35 patients with various chronic proteinuric renal disorders with or without renal failure, arterial hypertension and nephrotic syndrome. Before the start of ACE inhibition mean Calb/Ccreat, MAP, s-albumin and s-creatinine did not change. During ACE inhibition the Calb/Ccreat was reduced from 75% (p less than 0.05) in patients with minimal albuminuria to 41% (p less than 0.005) in patients with extensive albuminuria. Average reduction of albuminuria was 44% at one year's observation time. Serum albumin increased 9% (p less than 0.05), serum creatinine did not change significantly and MAP showed a slight, not uniformly significant decrease. The reduction of Calb/Ccreat was of the same order in the different renal disorders studied and was independent of the renal function, presence or absence of nephrotic syndrome and treatment with antihypertensive or immunosuppressive drugs. The decrease in Calb/Ccreat during ACE inhibition was related to the reduction in MAP at most time intervals, but Calb/Ccreat decreased also when MAP was unchanged or increased. Thus the decrease in Calb/Ccreat during ACE inhibition does not only seem to be a consequence of a decrease in the systemic arterial blood pressure but reasonably also due to changes in the intra-renal hemodynamics and most probably a decrease in the glomerular capillary pressure.
在35例患有各种慢性蛋白尿性肾脏疾病（伴有或不伴有肾衰竭、动脉高血压和肾病综合征）的患者中，在开始使用血管紧张素转换酶（ACE）抑制剂之前、开始使用时以及使用卡托普利或依那普利进行长达1年的ACE抑制治疗期间，研究了通过白蛋白肌酐清除率（Calb/Ccreat）测量的尿白蛋白排泄量和平均仰卧位动脉血压（MAP）。在开始ACE抑制治疗之前，平均Calb/Ccreat、MAP、血清白蛋白和血清肌酐没有变化。在ACE抑制治疗期间，Calb/Ccreat在微量白蛋白尿患者中从75%（p<0.05）降至大量白蛋白尿患者中的41%（p<0.005）。在一年的观察期内，蛋白尿平均减少了44%。血清白蛋白增加了9%（p<0.05），血清肌酐没有显著变化，MAP略有下降，但并非均有显著意义。在研究的不同肾脏疾病中，Calb/Ccreat的降低程度相同，且与肾功能、是否存在肾病综合征以及是否使用抗高血压或免疫抑制药物无关。在ACE抑制治疗期间，Calb/Ccreat的降低在大多数时间间隔与MAP的降低有关，但当MAP不变或升高时，Calb/Ccreat也会降低。因此，ACE抑制治疗期间Calb/Ccreat的降低似乎不仅是全身动脉血压降低的结果，而且合理地还归因于肾内血流动力学的变化，很可能是肾小球毛细血管压力的降低。
