双重阻断肾素-血管紧张素系统对慢性肾脏疾病血压、蛋白尿和肾功能的影响

目的 观察长程应用ACEI联合ARB治疗慢性肾脏疾病的疗效和安全性。 方法 60例慢性肾脏疾病患者随机分为3组：ACEI组、ARB组和联合组，ACEI组接受贝那普利治疗，ARB组接受缬沙坦治疗，联合组接受贝那普利联合缬沙坦治疗。观察治疗后1、3、6、9和12个月的相关临床指标变化，并进行评价。 结果 3 组患者经过12个月治疗后，24 h尿蛋白从(1.08±0.68) g降至(0.27±0.29) g，P < 0.05；收缩压从(129±24) mm Hg降至(116±18) mm Hg(P < 0.05)；肾小球滤过率从(67.5±30.2)ml/min升至(69.3±34.6)ml/min(P > 0.05)；血钾变化不大(P > 0.05)；不良反应轻微。3 组相比，联合组有最强的减少尿蛋白和降低舒张压作用(P < 0.05)，而在肾功能改善、血钾变化及不良反应方面，3 组间差异无统计学意义(P > 0.05)。结论 长期联合治疗双重阻断RAS系统有更强地降低蛋白尿和舒张压作用，而不良反应轻微。

Randomized controlled trial of dual blockage of renin-angiotensin system on the proteinuria,blood pressure and renal function in chronic kidney diseases

Objective To investigate the effect of ACEI combining with ARB on chronic kidney disease. Methods A randomized control trial was carried out in sixty chronic kidney disease patients， who were divided into ACEI group， ARB group and combined group. The ACEI group received lotensin， and the ARB group received volsartan， while the combined group received therapy of lotensin and volsartan. Clinical data were collected in the beginning， 3rd month， 6th month， 9th month and 12th month. Results Proteinuria of 24 h (1.08±0.68)g vs.(0.27±0.29)g]and systolic blood pressure (129±24) mm Hg vs. (116±18) mm Hg] were significantly decreased after 12 month therapy in all groups patients(P < 0.05)， while the GFR(67.5±30.2)ml/min vs. (69.3±34.6)ml/min]and the level of serum potassium in these patients remained the same after statistical analysis(P > 0.05). Combined therapy had the most noticeable antiproteinuric and blood pressure lowering effect， while renal function improvement，the level of serum potassium and the manifestations of side effects in combined group were similar to those in other two groups(P > 0.05).Conclusion Dual blockage of RAS with ACEI and ARB for long duration has better antiproteinuric and blood pressure lowering effect， and their side effect is mild.