Allon M, Pasque C B, Rodriguez M
Department of Medicine, University of Oklahoma College of Medicine, Oklahoma City.
J Lab Clin Med. 1990 Oct;116(4):462-8.
Captopril decreases protein excretion in patients with nephrosis. To evaluate whether captopril has an acute antiproteinuric effect and to evaluate the role of changes in renal hemodynamics or glomerular permselectivity on this effect, renal clearance studies were performed in patients without diabetes but with nephrosis. Protein excretion and renal hemodynamics were measured at baseline and after the administration of captopril. To measure the contribution of renal prostaglandins, patients were restudied on a separate day, after the combined administration of captopril and the prostaglandin synthetase inhibitor ibuprofen. Both treatments significantly reduced mean protein excretion, but the change was greater with combined therapy than with captopril alone (40.6% vs 20.0%). Mean glomerular filtration rate (GFR) decreased by 4.8% (not significant) and 16.5% (p less than 0.001), and filtration fraction (FF) decreased by 13.6% (p less than 0.001) and 14.9% (p less than 0.001) after captopril alone and combined therapy, respectively. No significant correlation was found between changes in proteinuria and changes in GFR or FF after treatment with captopril alone. In contrast, the decrease in proteinuria correlated with the change in GFR after combined drug administration (r = 0.68, p = 0.06). The ratio of immunoglobulin G to albumin clearance, an index of glomerular permselectivity, was unaffected by captopril but decreased significantly (by 43%) after combined drug administration. The results suggest that the acute antiproteinuric effect of captopril is not due to changes in FF, GFR, or glomerular perselectivity. The addition of ibuprofen enhances the antiproteinuric effect of captopril by decreasing the GFR as well as by enhancing the permselectivity of the glomerular capillary membrane.
卡托普利可减少肾病患者的蛋白质排泄。为评估卡托普利是否具有急性抗蛋白尿作用，并评估肾血流动力学变化或肾小球滤过选择性改变在该作用中的作用，对无糖尿病但患有肾病的患者进行了肾清除率研究。在基线和给予卡托普利后测量蛋白质排泄和肾血流动力学。为测定肾前列腺素的作用，在单独一天对患者重新进行研究，此次是在联合给予卡托普利和前列腺素合成酶抑制剂布洛芬之后。两种治疗均显著降低了平均蛋白质排泄，但联合治疗的变化比单独使用卡托普利时更大（40.6% 对 20.0%）。单独使用卡托普利和联合治疗后，平均肾小球滤过率（GFR）分别下降了 4.8%（无显著性差异）和 16.5%（p<0.001），滤过分数（FF）分别下降了 13.6%（p<0.001）和 14.9%（p<0.001）。单独使用卡托普利治疗后，蛋白尿变化与 GFR 或 FF 变化之间未发现显著相关性。相比之下，联合用药后蛋白尿的减少与 GFR 的变化相关（r = 0.68，p = 0.06）。免疫球蛋白 G 与白蛋白清除率之比是肾小球滤过选择性的一个指标，不受卡托普利影响，但联合用药后显著降低（降低 43%）。结果表明，卡托普利的急性抗蛋白尿作用并非由于 FF、GFR 或肾小球滤过选择性的改变。布洛芬的加入通过降低 GFR 以及增强肾小球毛细血管膜的滤过选择性来增强卡托普利的抗蛋白尿作用。
