Hod M, van Dijk D J, Karp M, Weintraub N, Rabinerson D, Bar J, Peled Y, Erman A, Boner G, Ovadia J
Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah Tiqva, Israel.
Nephrol Dial Transplant. 1995 Dec;10(12):2328-33. doi: 10.1093/ndt/10.12.2328.
Diabetic nephropathy is associated with an increase in perinatal mortality and morbidity in uncontrolled pregnant patients. Recently angiotensin-converting enzyme inhibitor (ACE-I) was shown to improve the disease status in non-pregnant subjects. The purpose of this study was to examine the effect of prepregnancy treatment of insulin-dependent diabetes mellitus (IDDM) nephrotic women with captopril angiotensin converting enzyme inhibitor (ACE-1), on maternal renal function throughout pregnancy and on the fetomaternal outcome.
Eight IDDM nephrotic patients planning pregnancy were treated with captopril for a minimum of 6 months prior to conception together with intensive insulin management. Conception was allowed when proteinuria was < 500 mg/day and euglycaemia was achieved. At conception captopril was discontinued.
At the beginning of captopril treatment, proteinuria was 1633 +/- 666 mg/day. At conception, proteinuria dropped to 273 +/- 146 mg/day (P = 0.0000) and increased gradually over the three trimesters to 593 +/- 515, 783 +/- 813, and 1000 +/- 1185 mg/day respectively (P = 0.2 between the trimesters); declining to 619 +/- 411 mg/day (P = 0.0002 vs conception) 3 months after delivery. Only in two patients (25%) did proteinuria exceed 1000 mg/day during pregnancy. There was no significant change in any of the other renal function tests: CCT, serum creatinine, uric acid, K+ and blood pressure. However, there were three cases of PET just prior to delivery. Maternal glycaemic control improved significantly prior to conception (P = 0.002) and remained euglycaemic (reflected by daily glucose profile, HbA1C and fructosamine) throughout gestation. Perinatal outcome was excellent.
Captopril treatment before pregnancy has a prolonged protective effect on maternal renal functions during pregnancy and results in a favourable maternal-fetal outcome.
糖尿病肾病与未得到控制的妊娠患者围产期死亡率及发病率的增加有关。最近有研究表明，血管紧张素转换酶抑制剂（ACE-I）可改善非妊娠患者的病情。本研究的目的是探讨在怀孕前用卡托普利（一种血管紧张素转换酶抑制剂，ACE-1）治疗胰岛素依赖型糖尿病（IDDM）肾病女性，对整个孕期母体肾功能以及母婴结局的影响。
8名计划怀孕的IDDM肾病患者在受孕前至少6个月接受卡托普利治疗，并同时进行强化胰岛素管理。当蛋白尿<500mg/天且血糖正常时允许受孕。受孕时停用卡托普利。
在开始卡托普利治疗时，蛋白尿为1633±666mg/天。受孕时，蛋白尿降至273±146mg/天（P = 0.0000），并在妊娠三期逐渐增加，分别达到593±515、783±813和1000±1185mg/天（三期之间P = 0.2）；产后3个月降至619±411mg/天（与受孕时相比P = 0.0002）。孕期只有2名患者（25%）蛋白尿超过1000mg/天。其他任何肾功能检查（CCT、血清肌酐、尿酸、钾离子和血压）均无显著变化。然而，分娩前有3例发生先兆子痫。受孕前母体血糖控制显著改善（P = 0.002），且在整个妊娠期血糖保持正常（通过每日血糖谱、糖化血红蛋白A1C和果糖胺反映）。围产期结局良好。
怀孕前进行卡托普利治疗对孕期母体肾功能有长期保护作用，并可带来良好母婴结局。
