Björck S, Nyberg G, Mulec H, Granerus G, Herlitz H, Aurell M
Br Med J (Clin Res Ed). 1986 Aug 23;293(6545):471-4. doi: 10.1136/bmj.293.6545.471.
The effects of angiotensin converting enzyme inhibition with captopril were investigated in patients with diabetic nephropathy and hypertension. After nine days' treatment with captopril glomerular filtration rate was unchanged in 13 patients, whereas renal plasma flow had increased from 265 to 302 ml/min/1.73 m2 body surface area (p less than 0.05) and the filtration fraction had decreased from 14.3 to 12.8% (p less than 0.025). During two years' treatment with captopril in 14 patients the mean arterial blood pressure had fallen by 5 mm Hg (p less than 0.005) and the deterioration in glomerular filtration rate had decreased from 10.3 to 2.4 ml/min/year (p less than 0.005). There was no correlation between the fall in blood pressure and the reduction in the deterioration of glomerular filtration rate. These findings suggest that the effects of angiotensin converting enzyme inhibition on renal haemodynamics protect renal function. Inhibitors of angiotensin converting enzyme should be considered for lowering blood pressure in patients with diabetic nephropathy.
在糖尿病肾病合并高血压患者中研究了卡托普利抑制血管紧张素转换酶的效果。13例患者经卡托普利治疗9天后，肾小球滤过率未变，而肾血浆流量从265ml/min/1.73m²体表面积增加到302ml/min/1.73m²体表面积（P<0.05），滤过分数从14.3%降至12.8%（P<0.025）。14例患者经卡托普利治疗两年后，平均动脉血压下降了5mmHg（P<0.005），肾小球滤过率的恶化程度从10.3ml/min/年降至2.4ml/min/年（P<0.005）。血压下降与肾小球滤过率恶化程度降低之间无相关性。这些发现提示血管紧张素转换酶抑制对肾血流动力学的作用可保护肾功能。对于糖尿病肾病患者，应考虑使用血管紧张素转换酶抑制剂来降低血压。
