Heeg J E, de Jong P E, van der Hem G K, de Zeeuw D
Department of Medicine, State University Hospital Groningen, The Netherlands.
Kidney Int. 1989 Aug;36(2):272-9. doi: 10.1038/ki.1989.190.
We studied the efficacy of the ACE inhibitor lisinopril in treating overt proteinuria in comparison with the NSAID indomethacin, and evaluated some of the conditions that could influence this antiproteinuric effect. In 12 patients with a proteinuria varying from 3.2 to 10.5 g/24 hr, a diastolic BP ranging from 64 to 105 mm Hg, and a GFR varying from 34 to 127 ml/min, the effect of different lisinopril doses and of changing dietary sodium intake was evaluated. Proteinuria fell by 27 +/- 20% from 6.1 +/- 2.1 to 4.5 +/- 1.9 g/24 hr on a low dose (median 5 mg/day) lisinopril and by 50 +/- 17% to 3.1 +/- 1.4 g/24 hr on a higher dose (median 10 mg/day), irrespective of initial proteinuria, BP, or GFR. This antiproteinuric effect was abolished by increasing salt intake from 50 to 200 mmol/day, and was recovered again by re-instituting the sodium restricted diet. The antiproteinuric effect of 10 mg/day lisinopril was comparable to the reduction in proteinuria (by 57 +/- 21% to 2.8 +/- 2.0 g/24 hr) on 150 mg/day indomethacin, while adverse effects were less and renal hemodynamic effects were more favorable during lisinopril. In some patients it took several weeks before the effect of the ACE inhibitor on proteinuria was stabilized. Thus, the antiproteinuric effect of the ACE inhibitor lisinopril appears to be dose and time related, and is strongly dependent on dietary sodium restriction, whereas it does not depend on initial proteinuria, BP, or GFR. The effect is comparable to that of indomethacin, while adverse effects are less.
我们研究了血管紧张素转换酶（ACE）抑制剂赖诺普利与非甾体抗炎药吲哚美辛相比，在治疗显性蛋白尿方面的疗效，并评估了一些可能影响这种抗蛋白尿作用的条件。在12例蛋白尿范围为3.2至10.5g/24小时、舒张压范围为64至105mmHg、肾小球滤过率（GFR）范围为34至127ml/分钟的患者中，评估了不同剂量赖诺普利和改变饮食中钠摄入量的效果。低剂量（中位数为5mg/天）赖诺普利治疗时，蛋白尿从6.1±2.1g/24小时降至4.5±1.9g/24小时，下降了27±20%；高剂量（中位数为10mg/天）时，蛋白尿降至3.1±1.4g/24小时，下降了50±17%，与初始蛋白尿、血压或GFR无关。当盐摄入量从50mmol/天增加到200mmol/天时，这种抗蛋白尿作用消失，重新采用限钠饮食后又恢复。每天10mg赖诺普利的抗蛋白尿作用与每天150mg吲哚美辛使蛋白尿减少（57±21%至2.8±2.0g/24小时）的效果相当，而赖诺普利治疗期间不良反应较少，对肾脏血流动力学的影响更有利。在一些患者中，ACE抑制剂对蛋白尿的作用需要数周才能稳定。因此，ACE抑制剂赖诺普利的抗蛋白尿作用似乎与剂量和时间有关，并且强烈依赖于饮食中钠的限制，而不依赖于初始蛋白尿、血压或GFR。其效果与吲哚美辛相当，但不良反应较少。
