摘要
目的观察增大剂量的福辛普利对于慢性肾脏病患者轻、中度蛋白尿(1-3.5g/24h)的有效性和安全性。方法采用前瞻性、多中心、自身对照试验,为期24周。84例纳入研究的患者中,其中67例有肾穿刺的病理诊断,11例失访。福辛普利的剂量每8周在原有基础上增加1倍。治疗过程中检测血常规、尿常规、24h尿蛋白定量、Scr、血电解质和肝功能,并记录血压及不良反应情况。结果患者24h蛋白尿定量试验前为(2.48±1.03)g,8周时降至(1.97±0.77)g(P<0.01);16周时降至(1.43±0.34)g(P<0.01);24周时降至(0.86±0.57)g(P<0.01)。24例(32.9％)完全缓解,27例(36.9％)部分缓解。试验前血压基线水平为(135.8±3.9/83.2±4.5)mmHg;8周时降至(129.5±8.8/79.5±7.3)mmHg(P<0.01);16周时血压为(119.2±7.8/70.5±9.5)mmHg(P<0.01);24周时血压为(114.6±11.9/67.2±9.5)mmHg。24例(32.8％)在服用福辛普利40mg/d时出现低血压的不良反应。结论福辛普利可显著减少慢性肾脏病患者的蛋白尿,并呈剂量依赖性。使用20mg/d的福辛普利是较为安全的,当剂量≥40mg/d时,应注意低血压的发生。
Objective To evaluate the antiproteinuric effect of increasing doses of ACE inhibitor fosinopril in patients with mild proteinuria (1-3.5 g/24 h), and investigate the tolerance in Chinese. Methods A prospective multicentric self-controlled clinical trail was performed. Eighty-four patients were enrolled in this prospective 24-week study of fosinopril.Dose of fosinopril was doubled every 8 weeks from the initial dose of 10 mg/d. Sixty-seven patients underwent percutaneous kidney biopsy. Laboratory parameters were detected every 2 weeks including complete blood count ,complete urine analysis, 24 hour urinary protein excretion, serum creatinine, serum electrolytes and liver function.Blood pressure and side effects were recorded simutaneously.Results Proteinuria decreased significantly with the increasing dose of fosinopril from baseline protein excretion of (2.48±1.03)g/24 h to (1.97±0.77)g/24 h(at the end of 8th week) (P < 0.01);then to (1.43±0.34)g/24 h(at the end of 16th week) (P < 0.01);finally to (0.86±0.57)g/24 h(at the end of 24th week) (P < 0.01). Twenty-four patients had complete remission and 27 patients had partial remission in this study. Blood pressure decreased from (135.8/83.2±3.9/4.5)mmHg to (129.5/79.5±8.8/7.3)mmHg(at the end of 8th week)(P < 0.01), then to (119.2/70.5±7.8/9.5)mmHg (at the end of 16th week) (P < 0.01);finally to (114.6/67.2±11.9/9.5)mmHg at the end of 24th week. Among these patients,24 had dizziness because of hypotension with the dose of fosinopril 40 mg. No significant change in serum creatinine was noted. Conclusion ACE inhibitor fosinopril reduces proteinuria in a dose-dependent manner. When giving fosinopril dose more than 40 mg/d, hypotension should be concerned.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2005年第1期9-12,共4页
Chinese Journal of Nephrology
