疏血通注射液联合缬沙坦治疗糖尿病肾病的临床观察

目的 观察疏血通注射液联合缬沙坦治疗早期糖尿病肾病(DN)及临床糖尿病肾病的临床疗效.方法 将60例患者随机分为对照组(缬沙坦)和治疗组(缬沙坦联合疏血通).比较两组治疗前和治疗后8周24 h尿微量白蛋白(UAER)、尿素氮(BUN)、血肌酐(Scr)等指标变化.结果 治疗后治疗组和对照组UAER均显著下降(P<0.05).治疗后治疗组Scr显著下降(P<0.05),而对照组则无明显改变.治疗后两组BUN、空腹血糖(FBG)、总胆固醇(TC)和三酰甘油(TG)均无明显变化.结论 疏血通注射液和缬沙坦联合治疗能有效减少早期DN和肾功能正常的临床DN患者的蛋白尿,改善肾功能.     

原发小血管炎肾损害几种治疗方案的疗效分析

目的 探讨临床常用方案对原发小血管炎肾损害患者肾损害方面的治疗效果.方法 收集近年住院治疗的确诊原发小血管炎合并肾损害的患者85例,根据实际治疗方案的不同分成5组:未用激素和环磷酰胺组,单用标准激素组,甲基泼尼松龙冲击+标准泼尼松方案组,口服泼尼松+环磷酰胺冲击组,甲基泼尼松龙+环磷酰胺双冲击组,对比分析各组患者治疗前后血尿、蛋白尿、血尿素氮和肌酐水平的改变.结果 ①5组患者治疗后的组间相比,不论是蛋白尿、血尿,还是血肌酐水平,差异均有统计学意义(P＜0.05),联合使用激素和环磷酰胺的患者血尿、蛋白尿程度和血肌酐水平明显下降；②治疗前后组内自身对照分析,单使用激素组,仅血尿有改善(P＜0.05),口服泼尼松+环磷酰胺冲击组,血尿和蛋白尿显著减轻(P＜0.05)；甲基泼尼松龙+环磷酰胺双冲击组,血尿和蛋白尿显著减轻(P＜0.05).结论 激素联合环磷酰胺方案对具有更好的肾脏损害治疗效果,优于单用激素,而不用激素和免疫抑抑制剂的方案,疗效欠佳.     

吗替麦考酚酯联合皮质类固醇激素治疗特发性局灶节段性肾小球硬化的临床观察

目的 探讨吗替麦考酚酯(MMF)联合皮质类固醇激素与环磷酰胺(CTX)联合皮质类固醇激素治疗特发性局灶节段性肾小球硬化(I-FSGS)的临床疗效及副反应.方法 将2004-2006年郑州大学第一附属医院肾内科住院治疗的30例I-FSGS患者随机分为2组:MMF联合皮质类固醇激素组(治疗组)与CTX联合皮质类固醇激素组(对照组),每组各15例.比较治疗组与对照组4,6,12个月24 h尿蛋白定量、血清白蛋白、肌酐清除率.结果 治疗4个月后,治疗组和对照组均较治疗前24 h尿蛋白定量明显减少(P<0.05),血清白蛋白和肌酐清除率均明显升高(P<0.05).6个月及12个月时,治疗组与对照组相比,24 h尿蛋白定量明显减少(P<0.05),血清白蛋白和肌酐清除率明显升高(P<0.05),总缓解率亦显著增加(P<0.05).治疗组主要副反应为消化道症状(2例),时照组主要副反应为肝脏损害(3例)、骨髓抑制(2例)、消化道症状(6例).结论 MMF联合皮质类固醇激素治疗I-FSGS临床疗效优于CTX联合皮质类固醇激素,且副反应较小.     

三氧化二砷对BXSB狼疮小鼠神经激肽A的影响及其意义探讨

目的 探讨不同浓度三氧化二砷(As2O3,ATO)对BXSB狼疮小鼠肾组织中神经激肽A(NKA)含量的影响及其意义.方法 BXSB狼疮小鼠50只随机分为5组,分别为对照组,系统性红斑狼疮(SLE)组,低剂量、中剂量和高剂量ATO组.常规检验治疗前后小鼠的血生化指标、组织化学法观察肾脏病理改变、酶联免疫吸附试验(ELISA)及反转录一聚合酶链反应(RT-PCR)法检测各组NKA及肾组织中NKA mRNA含量.结果 BXSB狼疮小鼠肾组织中NKA的含量(299±26)pg/g高于健康对照组(122±7)Dg/g,差异有统计学意义(P＜0.05).ATO作用BXSB狼疮小鼠后,其肾组织的NKA含量明显下降,大、中、小剂量组与治疗前的差异均具有统计学意义(P＜0.05).同时,各项生化指标及肾脏病理改变也明显改善(P＜0.05),尤其以小剂量ATO组效果更好(P＜0.01);小剂量ATO组中毒症状较轻,中、大剂量组中毒症状较重,两者差异有统计学意义(P＜0.05).结论 一定剂量的ATO对狼疮肾具有治疗作用,其机制可能是下调肾组织中NKA mRNA表达,其中小剂量ATO治疗狼疮肾,既安全又有效,具有一定的应用前景.     

不同剂量甘露醇对急性脑卒中患者电解质及肾功能的影响

目的 探讨不同剂量甘露醇对急性脑卒中患者电解质及肾功能的影响.方法 选择脑卒中患者470例,按照应用甘露醇的剂量分为125 mL剂量组(A组)与250 mL剂量组(B组).在用甘露醇前、用药第7天采血,测定血清肌酐、尿素氮、钾、钠、氯.结果 A、B组用药后各指标与用药前比较,均无统计学意义(P>0.05),B组尿素氮与A组比较有统计学意义(P<0.05).结论 常规剂量甘露醇对脑卒中患者应用安全有效.     

人参单体皂苷Rh_2与顺铂联合应用诱导小鼠前列腺癌凋亡

目的人参单体皂苷Rh2与顺铂联合应用诱导小鼠前列腺癌凋亡的作用。方法 C57BL-6J雄性小鼠40只,共分5组,Rh2组,顺铂(CDDP)小剂量组,CDDP大剂量组,Rh2+CDDP小剂量组,模型组。建立小鼠前列腺癌动物模型,于第三日开始给药1次/d,连续给药15 d。量取瘤,体重,计算抑瘤率。采用RT-PCR技术及免疫组化试剂盒检测前列腺癌组织中半胱氨酸蛋白酶-3(caspase-3)mRNA与蛋白的表达情况。结果 Rh2组与模型组小鼠体重相近(P>0.05)。Rh2与小剂量CDDP联合应用,抑瘤作用明显高于单纯小剂量CDDP的作用效果,其肿瘤抑制率与大剂量CDDP相近,Rh2与小剂量CDDP联合组caspase-3 mRNA及蛋白表达显著高于单纯CDDP及Rh2组(P<0.05)。结论人参单体皂苷Rh2与顺铂联合应用不但可以减少副作用而且可以通过明显增强caspase-3 mRNA表达而增强诱导小鼠前列腺癌细胞凋亡的作用。     

特利加压素联合大剂量白蛋白治疗老年肝肾综合征患者的疗效及安全性观察

目的 观察特利加压素联合大剂量白蛋白治疗老年肝肾综合征患者的疗效及安全性. 方法 30例患者随机分为对照组(13例)和试验组(17例).在内科综合治疗基础上,对照组予小剂量多巴胺联合大剂量白蛋白治疗;试验组使用特利加压素联合大剂量白蛋白,均连续使用7～14 d.观察患者临床症状、尿量、血肌酐、尿素氮、腹水消长情况、不良反应、终止治疗事件及治疗后的转归. 结果 试验组患者与治疗前相比,治疗1d后尿量明显增加(P＜0.01),血肌酐、尿素氮水平明显下降(P＜0.05).治疗第7天后比第3天后尿量进一步增加,血肌酐、尿素氮进一步降低(P＜0.05).同时患者腹水亦有所消退.而对照组患者治疗前后尿量、血肌酐及尿素氮水平无明显变化(P＞0.05). 结论 特利加压素联合大剂量白蛋白能有效治疗肝肾综合征,为老年肝肾综合征患者提供了一条安全有效的治疗途径.     

核因子-κB在糖尿病大鼠肾脏的表达水平及贝那普利的调节作用

目的 探讨NF-κB在糖尿病大鼠肾脏中的表达水平及贝那普利的调节作用.方法 将34只Wistar大鼠随机分为正常对照(n)组、糖尿病肾病(DN)组、贝那普利治疗(DNB)组.腹腔注射STZ诱导糖尿病模型,处理12 w末检测血糖、血胆固醇、血肌酐、尿素氮、尿蛋白,应用免疫组织化学方法检测肾脏NF-κB的表达水平.结果 DNB组大鼠血胆固醇、肌酐及尿白蛋白排泄较DN组明显减少(P<0.01或P<0.05).免疫组化显示:DNB组大鼠肾脏NF-κB表达明显低于DN组(P<0.01).结论 贝那普利对糖尿病大鼠肾脏有保护作用,可能通过抑制糖尿病大鼠肾脏NF-κB的表达,减少细胞外基质沉积.     

前列地尔及依帕司他治疗糖尿病肾病蛋白尿的临床可行性研究

目的探讨前列地尔及依帕司他治疗糖尿病肾病蛋白尿的临床可行性研究。方法将2016年1月—2017年1月收治的76例糖尿病肾病蛋白尿患者作为研究对象根据方法分组,各38例。对照组采用前列地尔治疗,联合治疗组采用前列地尔及依帕司他治疗。比较两组糖尿病肾病蛋白尿治疗总有效率;血糖达标时间、肾功能指标恢复正常时间、住院时间;干预前后患者血清内生肌酐清除率、24 h尿蛋白、尿微量白蛋白、平均尿素氮水平;不良反应发生率;治疗前后IL-6、hs-CRP、IL-1β水平。结果联合治疗组糖尿病肾病蛋白尿治疗总有效率高于对照组,差异有统计学意义(P0.05);联合治疗组血糖达标时间、肾功能指标恢复正常时间、住院时间短于对照组,差异有统计学意义(P0.05);干预前两组血清内生肌酐清除率、24 h尿蛋白、尿微量白蛋白、平均尿素氮水平相近,差异无统计学意义(P0.05);干预后联合治疗组血清内生肌酐清除率、24 h尿蛋白、尿微量白蛋白、平均尿素氮水平优于对照组,差异有统计学意义(P0.05)。两组患者均未出现严重不良反应。干预前两组IL-6、hs-CRP、IL-1β水平相近,差异无统计学意义(P0.05);干预后联合治疗组IL-6、hs-CRP、IL-1β水平优于对照组,差异有统计学意义(P0.05)。结论前列地尔及依帕司他治疗糖尿病肾病蛋白尿的临床可行性高,可有效改善患者病情,加速血糖达标和肾功能恢复,降低机体炎症水平,缩短疗程,且无严重不良反应,在治疗上具有可行性和安全性,值得推广。     

人参皂苷Compound K对动脉粥样硬化形成的影响

目的:本研究旨在探讨人参皂苷Compound K(CK)对动脉粥样硬化(As)形成的影响及其可能的作用机制。方法:30只,雄性,C57BL/6 apo E~(-/-)小鼠,随机分成五组,对照组(普通饮食);模型组(高脂饮食);低剂量CK组(高脂饮食+1mg/kg人参皂苷Compound K);中剂量CK组(高脂饮食+3mg/kg人参皂苷Compound K);高剂量CK组(高脂饮食+9mg/kg人参皂苷Compound K)。每周记录1次小鼠的质量变化,12周后观察小鼠的血脂水平、主动脉及泡沫细胞内胆固醇含量,观察主动脉斑块形成及肝脏内脂滴沉积情况。结果:(1)5组apo E~(-/-)小鼠在12周内质量均明显增加,各高脂饮食组的质量增长均显著快于对照组(P<0.05),但高脂饮食组间质量增长差异无统计学意义(P>0.05);(2)模型组的TC,TG和LDL-C水平显著高于对照组(P<0.05);中剂量CK组和高剂量CK组的HDL-C水平显著高于模型组(P<0.05),LDL-C水平低于模型组(P<0.05);(3)模型组小鼠肝脏内有明显的脂滴沉积,脂滴所占面积为(31.03±4.46)%;而中剂量、高剂量CK组肝脏内脂滴明显减少,分别为[(10.60±1.97)vs.(5.21±1.23)%];(4)模型组有明显的动脉硬化斑块形成,斑块面积为(15.34±2.00)%,中剂量、高剂量CK组在CK的作用下斑块面积均显著减少,分别为[(6.64±1.11)vs.(3.56±0.48)%];(5)与对照组相比,模型组泡沫细胞内的CE水平较高(P<0.05);与模型组相比,中剂量、高剂量CK组泡沫细胞内的CE(胆固醇酯)均明显降低(P<0.05);(6)主动脉可见泡沫细胞、纤维斑块和钙化灶等各期的病理改变,以纤维斑块为主。模型组小鼠的脂质沉积最多,内皮细胞可见损伤和脱落,而高剂量CK组小鼠情况要好于模型组。结论:人参皂苷Compound K可降低主动脉内的胆固醇的含量,减少泡沫细胞中胆固醇酯含量,促进脂质代谢,减少肝脏中脂质的沉积,显著抑制apo E-/-小鼠As斑块的形成。     

大黄和黄芪水提醇沉液注射治疗BXSB狼疮鼠的实验研究

目的 为了开发治疗系统性红斑狼疮（SLE）的新药，我们应用大黄、黄芪溶液注射治疗BXSB狼疮样小鼠，以观察其疗效。方法 应用水提醇沉法制取大黄黄芪溶液，15只BXSB雄性小鼠及6只雌鼠被随机分成三组，分别应用大黄黄芪溶液、地塞米松及生理盐水腹部皮下注射。考马斯亮蓝分光度法被用来检测小鼠尿蛋白含量，应用免疫荧光法检测小鼠血清抗核抗体（ANA）滴度及肾内免疫复合物沉积。结果 中药组及地塞米松组BXSB小鼠的尿蛋白含量及血清ANA滴度均明显低于生理盐水组（P＜0．01或P＜0．05），两组肾内免疫复合物沉积也轻于生理盐水组（P＜0．05）加药组BXSB小鼠的24h尿蛋白含量低于地塞米松组（P＜0．05）。结论 大黄、黄芪水提醇沉液可降低BXSB小鼠尿蛋白含量及血清ANA滴度，减少肾内免疫复合物沉积，对BXSB狼疮样小鼠有较为肯定的疗效。     

Clinical manifestations and progression of IgM mesangial nephropathy: a single center prospective

Out of 732 renal biopsies performed from 1988 to 1995 in Queen Elizabeth Hospital, 65 patients (8.9%, 43 male, 22 female) were diagnosed to have IgM mesangial nephropathy (IgMN). The mean age of the patients was 35 ±2 years. The clinical manifestations and progression of IgMN were studied in 39 of these 65 patients. The initial manifestations of the disease included nephrotic syndrome in 18 patients (46%), proteinuria and hematuria in nine patients (23%), non-nephrotic proteinuria in 11 patients (28%) and isolated hematuria in one patient (3%). The nephrotic syndrome was steroid-responsive in 16 of the 18 patients (89%) and six of them (33%) were steroid dependent. Two of the 11 (18%) patients in the isolated proteinuria group had a progressive deterioration in renal function. The renal function of the patients presented as hematuria with or without proteinuria remained stable during the follow-up period. We concluded that IgMN appeared to be a heterogeneous disease. Further studies on the classification and treatment are warranted in this group of patients.     

Cellular crescents and segmental glomerular necrosis in IgA nephropathy are indicative of the beneficial effects of corticosteroid therapy

OBJECTIVE: Recent reports have revealed that corticosteroid (PSL) therapy has a long-term beneficial effect for stabilization of renal function in progressive IgA nephropathy. PATIENTS AND METHODS: We analyzed serum creatinine (Cr), daily proteinuria and the results of other routine laboratory examinations during a short-term course of PSL therapy in 28 cases of progressive IgA nephropathy. The cases were divided into two groups according to changes in renal function during the PSL treatment period: group I (15 cases), improved renal function; group II (13 cases), no significant change in renal function. RESULTS: In group I, serum Cr and proteinuria were significantly decreased, with maximum effects observed at 3 months of PSL therapy, and remained low during the period of treatment. In contrast, group II showed no significant changes in serum Cr levels during the period of therapy, although proteinuria was transiently decreased after 3 months of therapy. Histologically, cellular/fibrocellular (C/F) crescents and/or segmental glomerular necrosis (SGN) occurred with a significantly higher incidence in group I (87%) than in group II (46%) (p < 0.05). CONCLUSIONS: These results suggested that the early response to PSL in reducing serum Cr and proteinuria by 3 months of treatment may be clinically useful to predict the prognosis of IgA nephropathy and that C/F crescents and/ or SGN may be histologically indicative of the beneficial effects of PSL therapy in IgA nephropathy.     

Inhibition of proteinuria development in aging Sprague-Dawley rats and C57BL/6 mice by long-term treatment with dehydroepiandrosterone

Dehydroepiandrosterone (DHEA) is an adrenal steroid that previously has been shown to produce antiobesity, antidiabetic, cancer preventive, and antiautoimmune effects in laboratory rodents. DHEA, when administered in the diet to male Sprague-Dawley rats beginning at 2 months of age, inhibited the development of proteinuria at 19 months. The nontreated rats excreted 6.5 times as much urinary protein as the group treated with DHEA. Part of the effect of DHEA is apparently a result of reduced food intake in the treated rats (14% reduction), but this alone could not account for its action as a pair-fed group excreted significantly more urinary protein than the DHEA treated rats (2.3 times as much). A similar inhibition of proteinuria in 17-month-old male C57BL/6 mice was produced by DHEA treatment initiated at 10 months of age (5.8 times as much urinary protein excreted by non-DHEA treated mice). DHEA treatment reduced food intake by 11% in the C57BL/6 mice. This reduction in food intake had no apparent effect on proteinuria since a pair-fed group was found to excrete 6.5 times the amount of urinary protein as the DHEA-treated mice.     

Effective treatment of autoimmune disease and progressive renal disease by mixed bone-marrow transplantation that establishes a stable mixed chimerism in BXSB recipient mice

Male BXSB mice spontaneously develop autoimmune disease with features similar to systemic lupus erythematosus. To determine whether this autoimmune disease can be treated as well as prevented by bone-marrow transplantation (BMT) and, at the same time, whether the immunity functions of lethally irradiated recipients can be reconstituted fully, male BXSB mice were engrafted with mixed T cell-depleted marrow (TCDM) both from fully allogeneic autoimmune-resistant BALB/c mice and from syngeneic autoimmune-prone BXSB mice, after the onset of autoimmune disease in the recipient mice. BMT with mixed TCDM from both resistant and susceptible strains of mice (mixed BMT) established stable mixed chimerism, prolonged the median life span, and arrested development of glomerulonephritis in BXSB mice. BMT with mixed TCDM also reduced the formation of anti-DNA antibodies that are observed typically in male mice of this strain. Furthermore, mixed BMT reconstituted the primary antibody production in BXSB recipients impressively. These findings indicate that transplantation of allogeneic autoimmune-resistant TCDM plus syngeneic autoimmune-prone TCDM into lethally irradiated BXSB mice can be used to treat autoimmune and renal disease in this strain of mice. In addition, this dual bone-marrow transplantation reconstitutes the immunity functions and avoids the immunodeficiencies that occur regularly in fully allogeneic chimeras after total body irradiation. This report describes an effective treatment of progressive renal disease and autoimmunity by establishing a stable mixed chimerism of TCDM transplantation from allogeneic autoimmune-resistant BALB/c mice plus syngeneic autoimmune-prone BXSB mice into BXSB mice.     

Henoch Schonlein purpura in childhood: clinical analysis of 254 cases over a 3-year period

We aimed to evaluate the patients who were diagnosed as Henoch Schonlein purpura (HSP) for disease characteristics and prognosis of those with joint, gastrointestinal (GI), and renal involvement. Two hundred and fifty-four children who were followed up with the diagnosis of HSP in the Pediatric Nephrology Clinics of Meram Medical Faculty of Selcuk University and Medical Faculty of Gazi University between January 2003 and June 2006 were retrospectively evaluated. The clinical follow-up and treatment regimens of patients in whom renal biopsy was performed were evaluated in detail. The study group consisted of 254 children, 147 boys (57.8%) and 107 girls (42.2%), and the ratio of boys to girls was 1.37. The percentages of skin, joint, GI, and renal manifestations were 100%, 66%, 56%, and 30%, respectively. Eight patients had intussusception. Five of them recovered with steroid treatment only while three patients were operated on. Sixty-four patients (44%) with GI involvement had severe disease and were successfully treated with steroids. Renal biopsy was performed in 26 patients. Among those 26 patients, two of them recovered spontaneously within 3 and 4 weeks. Ten patients improved with only steroid treatment while 12 patients recovered with steroid and cyclophosphamide treatment. Two patients were resistant to steroid and cyclophosphamide treatment and were treated with cyclosporine A. We believe that steroid therapy given to the HSP patients with GI manifestations might be helpful to prevent probable complications such as GI bleeding and intussusception. In addition, combined therapy with steroid and cyclophosphamide can usually be an appropriate treatment for patients with nephrotic proteinuria.     

白藜芦醇对链脲佐菌素诱导糖尿病小鼠肾脏损伤的保护作用

目的观察白藜芦醇对链脲佐菌素诱导的Ⅰ型糖尿病小鼠肾脏损伤的保护作用,并探讨其可能的作用机制。方法2018年6月—2019年11月期间取6~8周龄C57BL/6小鼠60只,其中正常小鼠20只,腹腔注射链脲霉素(STZ)诱导的糖尿病小鼠40只。实验所用C57BL/6小鼠分为3组:正常对照组(20只)、糖尿病组(20只)和糖尿病白芦藜醇治疗组(20只)。于糖尿病小鼠建模后5个月检测各组小鼠24 h蛋白尿、血液尿素氮(BUN)及血肌酐(Cr)等肾功能相关指标。评估各组小鼠肾脏肥大指数(肾重/体重)水平。利用试剂盒法检测各组小鼠肾脏皮质超氧化物歧化酶(SOD)活性、脂质过氧化代谢产物丙二醛(MDA)含量。取各组小鼠肾脏组织病理切片观察肾脏病理改变。采用TUNEL凋亡试剂盒检测各组小鼠肾脏组织细胞凋亡情况。Western blot及Real time-PCR法检测各组小鼠肾脏皮质血管内皮生长因子(VEGF),和核因子κB(NF-κB)等关键因子表达水平。利用免疫荧光组织化学染色技术观察各组小鼠肾脏组织VEGF表达情况。结果糖尿病白藜芦醇治疗组小鼠24 h尿蛋白、尿素氮(BUN)、血肌酐(Cr)和脂质过氧化代谢产物丙二醛(MDA)含量水平较糖尿病组明显降低,差异有统计学意义(P<0.05);糖尿病白藜芦醇治疗组小鼠肾脏皮质超氧化物歧化酶(SOD)活性较糖尿病组小鼠明显升高;HE病理染色显示白芦藜醇治疗组小鼠肾脏损害较糖尿病组小鼠减轻;TUNEL凋亡染色显示糖尿病白芦藜醇治疗组肾脏细胞凋亡水平较糖尿病组明显减轻;Western blot和RT-PCR结果显示,糖尿病白藜芦醇治疗组VEGF与NF-κB mRNA和蛋白表达水平较糖尿病组明显降低,差异有统计学意义(P<0.05);免疫荧光染色结果显示,糖尿病白藜芦醇治疗组VEGF荧光强度较糖尿病组明显降低。结论白藜芦醇能够明显改善糖尿病小鼠肾脏损伤,其作用机制可能是通过减少肾脏组织细胞凋亡、抗VEGF表达及抗炎作用。     

低分子量肝素对增殖性肾炎的疗效观察

为观察低分子量肝素对增殖性肾炎的治疗作用，对４１例经肾活检证实组织学改变都有明显的系膜细胞增殖，并有不同程度硬化和肾小球内凝血的患者，按年龄、病程、临床表现及肾组织病变程度随机分为两组。对照组用激素、环磷酰胺和洛汀新；观察组在上述药物治疗基础上每日一次皮下注射低分子量肝素速避凝３０７５～６１５０ＩＵＡＸａ。结果表明，用低分子量肝素治疗组患者治疗４周后尿蛋白明显减少，血清白蛋白明显增高，总胆固醇下降，其中尿蛋白和血清白蛋白的变化与对照组比较差异有显著性（Ｐ＜０．０５）。虽然４周时各组治疗前后及两组间肌酐清除率变化差异无显著性，但８周及１２周时，两组间肌酐清除率差值的比较具有显著性意义（Ｐ＜０．０５），观察组肌酐清降率呈上升趋势。本研究提示低分子量肝素可使具有肾小球内凝血和硬化的增殖性肾炎患者尿蛋白减少，有利于肾病综合征早期缓解，而且出血危险性小，无需特别监护，便于长期应用。     

Low-dose combination therapy with temocapril and losartan reduces proteinuria in normotensive patients with immunoglobulin a nephropathy.

This study investigates the ability of low doses of angiotensin-converting-enzyme inhibitors, in combination with angiotensin II receptor blockers, to exert antiproteinuric effects in normotensive and proteinuric outpatients with immunoglobulin A (IgA) nephropathy confirmed by biopsy. We performed a prospective, randomized, 6-month study of the effects of temocapril 1 mg (n=10), losartan 12.5 mg (n=10), and both (n=11) on mild-to-moderate proteinuria 0.76+/-0.35 g/day (range, 0.4 to 1.6 g/day) and renal function. The study subjects comprised 31 normotensive and proteinuric outpatients with IgA nephropathy accompanied by normal, or mild-to-moderately reduced but stable renal function (glomerular filtration rate>50 ml/min) without steroid or immunosuppressive therapy. We prospectively evaluated blood pressure, proteinuria, renal function and biochemical parameters before and after 6 months of therapy. The combination therapy significantly reduced proteinuria (63.2%) compared with either temocapril or losartan alone (41.3% and 36.6%, respectively, p=0.04 and 0.01, respectively). Blood pressure was most decreased in the group that received combination therapy. The reduced proteinuria did not correlate with reduced systolic or diastolic blood pressure or mean arterial pressure in any of the groups. The glomerular filtration rate fell during the first 3 months of combined therapy, but became reversible after a further 3 months of therapy. The combination significantly decreased angiotensin II (p <0.01), and this decrease was greater than that by either drug alone. In conclusion, the effectiveness of the combined therapy may have been at least partly due to the greater inhibition of the action of angiotensin II in patients with IgA nephropathy. This strategy apparently reduced mild-to-moderate proteinuria in patients with normotensive IgA nephropathy.