Sitprija V, Lumlertgul D
Department of Medicine, Chulalongkorn University, Bangkok.
J Med Assoc Thai. 1993 Jul;76(7):359-67.
To evaluate the renal protection of enalapril a study was made in 37 patients with chronic renal failure and hypertension. Sixteen patients had diabetic nephropathy with the serum creatinine ranging from 2.0 to 4.0 mg/dl. Twenty-one patients had non-diabetic chronic renal failure with serum creatinine from 2.2 to 6.3 mg/dl. Of 16 patients with diabetic nephropathy, 6 served as control and 10 received enalapril. Nine patients in the non-diabetic chronic renal failure group served as controls, while 12 were given enalapril. The control patients received alpha methyldopa (500 mg/day) for blood pressure control. In the studied patients enalapril was given at the dose of 5-10 mg/day. Over a period of 2 yrs, enalapril attenuated progression of renal failure in patients with diabetic nephropathy at the serum creatinine level from 2 to 2.9 mg/dl (creatinine clearance 21.5-38.4 ml/min) when compared with control patients. At the serum creatinine of 3 to 4 mg/dl progression of renal failure did not differ from control patients. In non-diabetic renal failure progression of renal failure was delayed in patients with serum creatinine level ranging from 2.2 to 5 mg/dl (creatinine clearance 18-42 ml/min); patients with serum creatinine level ranging from 5.5 to 6.3 mg/dl had deterioration of renal function as control patients. Proteinuria was decreased in all patients on enalapril. Thus, for preventing progression of renal failure, enalapril should be given in chronic renal failure with milder degree of renal function impairment; in diabetic nephropathy it should be started earlier at the lower serum creatinine level than in non-diabetic chronic renal failure, yet with comparable creatinine clearance.
为评估依那普利的肾脏保护作用，对37例慢性肾衰竭合并高血压患者进行了一项研究。16例患者患有糖尿病肾病，血清肌酐范围为2.0至4.0mg/dl。21例患者患有非糖尿病慢性肾衰竭，血清肌酐为2.2至6.3mg/dl。在16例糖尿病肾病患者中，6例作为对照，10例接受依那普利治疗。非糖尿病慢性肾衰竭组中有9例患者作为对照，12例给予依那普利。对照患者接受α-甲基多巴（500mg/天）以控制血压。在研究患者中，依那普利的给药剂量为5-10mg/天。在2年的时间里，与对照患者相比，依那普利使血清肌酐水平在2至2.9mg/dl（肌酐清除率21.5-38.4ml/min）的糖尿病肾病患者的肾衰竭进展减缓。在血清肌酐为3至4mg/dl时，肾衰竭进展与对照患者无差异。在非糖尿病肾衰竭中，血清肌酐水平在2.2至5mg/dl（肌酐清除率18-42ml/min）的患者肾衰竭进展延迟；血清肌酐水平在5.5至6.3mg/dl的患者肾功能恶化情况与对照患者相同。所有接受依那普利治疗的患者蛋白尿均减少。因此，为预防肾衰竭进展，依那普利应给予肾功能损害程度较轻的慢性肾衰竭患者；在糖尿病肾病中，应在血清肌酐水平低于非糖尿病慢性肾衰竭时更早开始使用，且肌酐清除率相当。
