Osterziel K J, Nagel F, Dietz R
Universitätsklinikum Rudolf Virchow, Franz-Volhard Klinik, Berlin.
Z Kardiol. 1994;83 Suppl 4:81-7.
Renal function in 31 patients with mild to moderate heart failure (NYHA Classes II-III) was studied before and during treatment with ACE-inhibitors. Maximal treatment doses were based on randomization: captopril 3 x 12.5 mg or lisinopril or enalapril, both 1 x 10 mg. Before therapy and at the end of titration phase (after 6 days) glomerular filtration rate and renal blood flow were determined from inulin and PAH clearance (steady-state method). In the total study group the median arterial pressure significantly decreased from 94 mmHg to 84 mmHg (p < 0.01), whereas glomerular filtration rate was only moderately, however, significantly reduced from 103 ml/min to 97 ml/min (median values, p < 0.01). Renal blood flow, however, increased from 372 ml/min to 403 ml/min (p < 0.01). Changes in glomerular filtration rate (GFRd) were significantly dependent on those of renal blood flow (GFRd = 0.07 RPFd - 9.2; p < 0.05). All three ACE-inhibitors showed similar changes in glomerular filtration rate and renal blood flow. Ten of the patients had additionally received cyclooxygenase inhibitors. With respect to severity of heart failure and renal function these patients did not differ from the remaining 21 patients of the group. In both groups, a decrease of glomerular filtration rate was found, however, in those patients who had received acetylsalicylic acid there was no increase of renal blood flow.
A small, however significant decrease of glomerular filtration rate is already seen in patients with mild to moderate heart failure treated with ACE-inhibitors. Increase of renal blood flow counteracts the decrease of glomerular filtration rate. During concomitant application of acetylsalicylic acid the increase of renal blood flow remains absent.
对31例轻至中度心力衰竭（纽约心脏协会II - III级）患者在使用血管紧张素转换酶抑制剂（ACE抑制剂）治疗前及治疗期间的肾功能进行了研究。最大治疗剂量基于随机分组：卡托普利3×12.5毫克或赖诺普利或依那普利，均为1×10毫克。在治疗前及滴定阶段结束时（6天后），通过菊粉和对氨基马尿酸清除率（稳态法）测定肾小球滤过率和肾血流量。在整个研究组中，平均动脉压从94毫米汞柱显著降至84毫米汞柱（p < 0.01），而肾小球滤过率仅适度但显著降低，从103毫升/分钟降至97毫升/分钟（中位数，p < 0.01）。然而，肾血流量从372毫升/分钟增加至403毫升/分钟（p < 0.01）。肾小球滤过率的变化（GFRd）显著依赖于肾血流量的变化（GFRd = 0.07 RPFd - 9.2；p < 0.05）。所有三种ACE抑制剂在肾小球滤过率和肾血流量方面均显示出相似的变化。其中10例患者还额外接受了环氧化酶抑制剂。就心力衰竭的严重程度和肾功能而言，这些患者与该组其余21例患者并无差异。在两组中均发现肾小球滤过率下降，然而，在接受乙酰水杨酸的患者中，肾血流量并未增加。
在接受ACE抑制剂治疗的轻至中度心力衰竭患者中，已观察到肾小球滤过率有轻微但显著的下降。肾血流量的增加抵消了肾小球滤过率的下降。在同时应用乙酰水杨酸时，肾血流量的增加不存在。
