调整免疫抑制方案改善移植肾功能

目的：探讨调整免疫抑制药的使用方案能否改善肾移植后慢性移植物肾病患者的肾功能。方法：对32例(A组)慢性移植物肾病早期肾功不全的患者在1～2周内将其神经钙蛋白阻滞药(环孢素A或他克莫司)减少至原剂量的1／3或完全停用，同时适当增加硫唑嘌呤或霉酚酸酯(MMF)的用量，与同期内环孢素A或他克莫司未作大幅度减量、仅适当增加硫唑嘌呤或霉酚酸酯用量的26例(B组)慢性移植物肾病患者进行对比，随访比较两组的移植肾功能，观察急性排斥反应情况。结果：1年后A组有21例(65．6％)患者移植肾功能得以好转或不再继续恶化，而B组除3例(11．5％)移植肾功能维持在原有水平外，其他患者肾功能均进行性恶化。两组急性排斥反应发生率无显著差异。结论：大幅度减少甚至停用神经钙蛋白阻滞药可使部分肾移植后慢性移植物肾病患者的肾功能得以改善或者防止其进行性恶化。这种药物调整是安全的。     

肾移植患者神经钙蛋白阻滞药的肾毒性

目的:了解减少或停用神经钙蛋白阻滞药能否改善肾移植后慢性移植物肾病患者的肾功能.方法:1999年1月～2001年5月期间,对病理诊断为慢性移植物肾病(Ⅰ级)肾功不全的93例肾移植患者随机分为A、B两组,A组(50例):在1～2周内将其神经钙蛋白阻滞药(环孢素或他克莫司)减少至原剂量的三分之一或完全停用,同时适当增加硫唑嘌呤或霉酚酸脂的用量;B组(43例):环孢素A或他克莫司未作大幅度减量、而是仅适当增加硫唑嘌呤或霉酚酸脂的用量.对两组患者进行至少3年的随访,比较其移植肾功能、观察两组急性排斥反应有无差异等.结果:3年后A组有31例(62.0%)患者移植肾功能得以好转或不再继续恶化,而B组除4例(9.3%)移植肾功能维持在原有水平外,其他患者肾功能均进行性恶化;3年后A组肾功能明显好于B组;B组3年后尿蛋白定量明显增多,而A组无明显改变;两组急性排斥反应发生率无显著差异.结论:大幅度减少甚至停用神经钙蛋白阻滞药可使部分肾移植后慢性移植物肾病患者的肾功能得以改善或者阻止其进行性恶化.这种药物调整是安全的.     

调气活血补肾汤治疗慢性肾功能衰竭疗效分析

目的：探讨调气活血补肾汤治疗慢性肾功能衰竭的疗效。方法选择该院收治的72例慢性肾功能衰竭患者作为实验对象,随机分为试验组和对照组,每组36例;对照组进行使用优质低蛋白、低磷饮食,对症治疗,试验组给予调气活血补肾汤治疗,每日1剂,水煎服,早晚各1次,连续治疗3个月为1个疗程。观测肾功能（ BUN、Scr、Ccr）、血红蛋白判定临床疗效。结果试验组治疗后Scr、BUN均明显降低,Ccr明显升高,与治疗前比较差异有统计学意义（ P ＜0à．05）;对照组治疗后Scr BUN明显降低,与治疗前比较差异有统计学意义（ P ＜0．05）;试验组治疗后Scr明显低于对照组,Ccr明显高于对照组,差异有统计学意义（ P ＜0．05）;试验组治疗后血红蛋白较治疗前明显升高差异有统计学意义（ P ＜0．05）,试验组治疗后血红蛋白高于对照组,差异有统计学意义（ P ＜0．05）;试验组治疗显效率和总有效率均明显高于对照组,差异有统计学意义（ P ＜0．05）。结论调气活血补肾汤治疗慢性肾功能衰竭效果明显,能显著改善患者贫血和肾功能,值得临床推广应用。     

慢性移植肾肾病患者他克莫司转换治疗的研究

目的：探讨慢性移植肾肾病（CAN）患者将环孢素A（CsA）替换为他克莫司（EK506）的临床疗效和安全性。方法：根据是否能以FK506替换CsA,将108例CAN患者分成两组,对照组40例,维持原免疫抑制方案CsA、霉酚酸酯及泼尼松联用不变;FK506组68例,除将CsA转换成FKS06外,其他用药同CsA组。分别监测两组患者替换治疗后1,3,6,12,24个月的肾功能、肝功能、血糖、血脂的变化情况及不良反应。结果：替换治疗后,FK506组血清肌酐、尿素氮、尿酸与替换前相比明显下降,而对照组却显著升高（P〈0．05或P〈0．01）,两组之间存在统计学差异（P〈0．05或P〈0．01）;对照组血脂在替换前后无明显变化,而FK506组总胆固醇（TC较替换前显著下降（P〈0．05）,两组的血糖均明显升高,TB与DB逐渐下降,但两组间无统计学差异（P〉0．05）。FK506组患者牙龈增生、毛发增多的发生率明显低于对照组（P〈0．05）。结论：慢性移植肾肾病患者用FK506替换CsA可延缓CAN进展,且具好较好的安全性。     

激素联合血管紧张素转换酶抑制剂治疗中度蛋白尿IgA肾病的临床分析

目的探讨激素联合血管紧张素转换酶抑制剂治疗中度蛋白尿IgA肾病患者的临床疗效。方法对2013年5月至2014年5月住院的已确诊是中度蛋白尿IgA肾病患者100例进行分组,其中试验组[激素联合血管紧张素转换酶抑制剂(ACEI)给药组]50例,对照组(单纯应用ACEI组)50例。用药期间监测24 h尿蛋白定量、血常规和肾功能等,比较两组临床疗效。结果实验组24 h尿蛋白和血肌酐水平与对照组同期相比均有所下降,具有显著性差异;两组患者24 h尿蛋白和血肌酐水平均较本组治疗前有所降低,随着治疗时间越长,降低的越明显,差值具有统计学意义(P<0.05或P<0.01),试验组经12个月治疗其总有效率(88%)高于对照组(46%)。结论激素联合血管紧张素转换酶抑制剂治疗中度蛋白尿IgA肾病患者具有很好的临床疗效,为临床治疗IgA肾病提供有效的治疗方案。     

肾移植术后应用雷帕霉素转换方案的临床观察

目的:探讨肾移植术后患者应用雷帕霉素进行转换治疗的安全性和有效性。方法:分析2012-2016年北京朝阳医院泌尿外科肾移植术后由传统钙调磷酸酶抑制剂(CNI)为主的方案转换为雷帕霉素免疫抑制方案的患者。所有患者转换前均使用环孢素/他克莫司联合霉酚酸/硫唑嘌呤及糖皮质激素作为初始免疫抑制方案。各免疫抑制剂的剂量根据血药浓度进行调整,使用三联方案的患者在转换当天停用他克莫司/环孢素,雷帕霉素浓度控制在4~10ng·mL^-1;使用四联方案的患者雷帕霉素浓度控制在3~7ng·mL^-1,他克莫司剂量为原来的1/3,浓度控制在2~5ng·mL^-1。分析患者转换前后1年血肌酐、蛋白尿、血常规和血生化指标;总结转换前后1年感染发生率和肿瘤患者转归。结果:33例患者转换1年后血肌酐水平下降,但结果差异无显著性[(112.36±63.82)μmol·L^-1比(108.17±55.41)μmol·L^-1,P=0.58]。甘油三酯和低密度脂蛋白胆固醇在转换后1年有明显增长(P=0.04、0.02),转氨酶水平变化差异无显著性(P=0.19、0.12)。转换前后1年血小板、血红蛋白、血糖变化无明显差异。转换前后巨细胞病毒感染(CMV)、卡氏肺孢子菌肺炎(PCP)感染降低,肿瘤患者复发率降低,蛋白尿呈双向改变。结论:肾移植术后患者应用雷帕霉素转换方案是安全、有效的。     

晓悉与环磷酰胺治疗难治性肾病综合征的疗效比较

目的比较晓悉与环磷酰胺治疗难治性肾病综合征的临床疗效、不良反应及复发率。方法将38例难治性肾病综合征患者随机分为治疗组与对照组各19例,治疗组予晓悉、中等剂量激素及雷公藤多甙片治疗,对照组在治疗组的基础上改晓悉为环磷酰胺。观察两组治疗前后24h尿蛋白、血肌酐、血浆白蛋白及综合疗效,观察两组治疗过程中的不良反应,并随访3个月,观察其复发率。结果两组均能明显降低患者的24h尿蛋白定量,升高血浆白蛋白,改善肾功能(P<0·05或P<0·01),但两组者比较差异无统计学意义(P>0·05);综合疗效比较亦差异无统计学意义(P>0·05);不良反应比较在肝功能受损、胃肠道症状及脱发方面差异有统计学意义(P<0·05);复发率差异无统计学意义(P>0·05)。结论晓悉治疗难治性肾病综合征疗效显著,不良反应少,值得进一步研究。     

灯盏花素注射液联合贝那普利治疗糖尿病肾病氮质血症期52例

目的观察灯盏花素注射液联合贝那普利对糖尿病肾病（DN）氮质血症期患者蛋白尿及肾功能的影响。方法将92例DN氮质血症期患者随机分为观察组52例及对照组40例,所有患者均接受低盐、低蛋白糖尿病饮食,对照组给予常规降糖、降压[不用血管紧张素转换酶抑制剂（ACEI）]及调脂治疗。观察组在对照组的基础上加用灯盏花素注射液40mg＋生理盐水250mL静脉滴注,1次／d,并口服贝那普利10mg,1次／d,连续4周。观察治疗前后空腹血糖、血压、血脂、24h尿蛋白定量（VAE）及肾功能。结果两组患者治疗前后空腹血糖组间比较差异无显著性（P〉0．05）。两组治疗后血压均低于治疗前,而观察组治疗后血压与对照组比较差异有显著性（P〈0．05）。治疗后观察组血脂明显下降（P〈0．05）,而对照组下降不明显（P〉0．05）。治疗后两组的尿蛋白、尿素氮、肌酐均有所下降,观察组下降明显,与对照组比较差异有显著性（P〈0．05）。结论灯盏花素注射液联合贝那普利不仅能改善DN患者的蛋白尿,同时还有改善血脂和肾功能的作用。     

前列地尔与小剂量多巴胺对慢性肾功能不全患者肾功能的影响

目的探讨前列地尔与小剂量多巴胺对慢性肾功能不全患者的肾功能的临床意义。方法选取2017年1月至2018年1月在大连市友谊医院肾内科就诊的80例难治性肾病综合征患者,随机分为对照组和试验组,对照组40例采取常规的低盐低蛋白饮食、利尿、降压、抗凝、保肾治疗,试验组40例使用前列地尔与小剂量多巴胺治疗,比较两组患者治疗后的肾功能。结果试验组肾功能优于对照组,差异有统计学意义(P<0.05)。结论对慢性肾功能不全患者使用前列地尔与小剂量多巴胺治疗,可以明显提高患者的肾功能,值得在临床推广。     

舒洛地特治疗慢性移植肾肾病蛋白尿疗效观察

目的探讨舒洛地特对移植。肾肾病蛋白尿的疗效。方法28例移植肾肾病伴蛋白尿的患者，分为治疗组14例（舒洛地特软胶囊500LSU／d，疗程3个月）和对照组14例（不使用舒洛地特），观察2组治疗前后24h尿蛋白定量、尿白蛋白排泄率（UAER）、纤维蛋白原（Fbg）、PT、TT、AFIT、血肌酐、尿素氮等指标。结果与治疗前相比，两组治疗后BUN、Cr、uA无明显变化（P〉0．05）。治疗组24h尿蛋白定量、尿白蛋白排泄率较治疗前明显下降（P〈0．05），治疗组与对照组相比有显著性差异（P〈0．05），纤维蛋白原（Fbg）较治疗前下降，差异有显著性（P〈0．05）；PT、TT、APTT均较治疗前延长，差异有显著性（P〈0．05）。结论舒洛地特能有效减少尿蛋白、抗凝从而起到保护移植肾肾功能的作用，无明显不良反应，使用安全有效。     

Use of sirolimus in solid organ transplantation

Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor that inhibits cell cycle progression and has proven to be a potent immunosuppressive agent for use in solid organ transplant recipients. The drug was initially studied as an adjunct to ciclosporin (cyclosporine) to prevent acute rejection in kidney transplant recipients. Subsequent studies have shown efficacy when combined with a variety of other immunosuppressive agents. The most common adverse effects of sirolimus are hyperlipidaemia and myelosuppression. The drug has unique antiatherogenic and antineoplastic properties, and may promote immunological tolerance and reduce the incidence of chronic allograft nephropathy. Although sirolimus is relatively non-nephrotoxic when administered as monotherapy, it pharmacodynamically enhances the toxicity of calcineurin inhibitors. Ironically, the drug has been used to facilitate calcineurin inhibitor-free protocols designed to preserve renal function after solid organ transplantation. Whether sirolimus can be used safely over the long term with low doses of calcineurin inhibitors requires further study. The use of sirolimus as a corticosteroid-sparing agent also remains to be proven in controlled trials. Postmarketing studies have revealed a number of unforeseen adverse effects including impaired wound healing and possibly proteinuria, oedema, pneumonitis and thrombotic microangiopathy. Overall, sirolimus is a powerful agent when used judiciously with other available immunosuppressants. As is true for all immunosuppressive drugs available for treatment of solid organ transplant recipients, the efficacy of the drug must be balanced against its considerable adverse effects.     

Sirolimus-associated proteinuria and renal dysfunction.

Sirolimus is a novel immunosuppressant with potent antiproliferative actions through its ability to inhibit the raptor-containing mammalian target of rapamycin protein kinase. Sirolimus represents a major therapeutic advance in the prevention of acute renal allograft rejection and chronic allograft nephropathy. Its role in the therapy of glomerulonephritis, autoimmunity, cystic renal diseases and renal cancer is under investigation. Because sirolimus does not share the vasomotor renal adverse effects exhibited by calcineurin inhibitors, it has been designated a 'non-nephrotoxic drug'. However, clinical reports suggest that, under some circumstances, sirolimus is associated with proteinuria and acute renal dysfunction. A common risk factor appears to be presence of pre-existing chronic renal damage. The mechanisms of sirolimus-associated proteinuria are multifactorial and may be due to an increase in glomerular capillary pressure following calcineurin inhibitor withdrawal. It has also been suggested that sirolimus directly causes increased glomerular permeability/injury, but evidence for this mechanism is currently inconclusive. The acute renal dysfunction associated with sirolimus (such as in delayed graft function) may be due to suppression of compensatory renal cell proliferation and survival/repair processes. Although these adverse effects occur in some patients, their occurrence could be minimised by knowledge of the molecular effects of sirolimus on the kidney, the use of sirolimus in appropriate patient populations, close monitoring of proteinuria and renal function, use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers if proteinuria occurs and withdrawal if needed. Further long-term analysis of renal allograft studies using sirolimus as de novo immunosuppression along with clinical and laboratory studies will refine these issues in the future.     

糖通饮对早期糖尿病肾病患者尿微量白蛋白排泄率、糖脂代谢的影响

目的：观察名老中医经验方糖通饮对早期糖尿病肾病患者尿微量白蛋白排泄率、糖脂代谢的影响。方法：将58例早期糖尿病肾病患者随机分为治疗组（30例）和对照组（28例）,分别治疗12周（2个疗程）后,比较两组治疗前后尿微量白蛋白排泄率、24h尿蛋白定量、糖化血红蛋白、血糖、血脂的变化。结果：治疗组治疗后尿微量白蛋白排泄率、24h尿蛋白定量、糖化血红蛋白、空腹血糖、甘油三酯、总胆固醇均明显下降（P<0.05或P<0.01）,与对照组比较差异显著（P<0.05）。结论：糖通饮能有效降低早期糖尿病肾病患者尿微量白蛋白排泄率,减轻蛋白尿,同时使空腹血糖、血脂及糖化血红蛋白得到改善,治疗早期糖尿病肾病疗效较好。     

Sirolimus use in recipients of expanded criteria donor kidneys

With changing donor characteristics and the growing shortage in organ supply, renal transplant practitioners have sought to optimize the use of expanded criteria donor (ECD) kidneys, which have poorer outcomes than standard criteria donor (SCD) kidneys. The outcomes may represent an acceptable trade-off if ECD transplants offer enhanced overall patient survival by reducing waiting times. ECD kidneys may be more susceptible to toxicity associated with calcineurin inhibitors (CNIs); therefore, a potential strategy to improve outcomes in this growing demographic is the use of CNI-free immunosuppressive protocols. To date, published clinical studies have demonstrated encouraging outcomes using sirolimus-based CNI-free regimens in SCD kidney transplant recipients. We conducted a pilot study to examine outcomes in ECD kidney transplant recipients receiving a CNI-free quadruple drug regimen, consisting of antithymocyte globulin (ATG), sirolimus, mycophenolate mofetil (MMF) and a corticosteroid, compared with outcomes in a retrospective CNI-control group of ECD recipients who had received standard CNI-based immunosuppressive treatment. Patient survival and allograft survival at 1 year were not significantly different between the CNI-free group (n = 13) and the CNI-control group (n = 13) [100% vs 92% and 92% vs 85%, respectively]; nor was the incidence of rejection (26% and 31%) or delayed graft function (38% of patients in both groups). Serum creatinine was significantly lower and the estimated glomerular filtration rate was significantly higher for the CNI-free group at 3-6 months but not at 1 year. Protocol biopsies in the CNI-free patients at 1 year revealed no significant progression of chronic vascular lesions. Banff chronic/sclerosing allograft nephropathy scores were 42% grade I, 25% grades II and III, and 33% grade 0. Thus, a sirolimus-based CNI-free regimen may improve outcomes in ECD kidney transplant recipients and merits further study.     

高张葡萄糖预防终末期糖尿病肾病血液透析中低血压临床疗效评估

目的 评价高张葡萄糖预防糖尿病肾病患者血液透析中低血压临床疗效。方法 将30例维持性血液透析〉6个月的糖尿病肾病患者分为治疗组（14例）及对照组（16例）两组。治疗组在血液透析中第3个小时通过静脉回路匀速注入50％葡萄溶液100ml，到透析结束时注射完成。对照组执行常规治疗。观察治疗前、治疗中每小时、及治疗结束时血压；用药前、后、午饭前、晚饭前血糖值；治疗前、后3个月后的糖化血红蛋白值。结果 治疗组第4个小时收缩压较对照组明显升高，差异具有统计学意义（P〈0．05）；治疗组透析结束时快速血糖明显高于对照组（P〈0．05）；治疗组治疗前后糖化血红蛋白定量差异无明显统计学意义（P〉0．05）。结论 高张葡萄糖可以有效地预防血液透析中低血压，虽然可以造成短暂的高血糖但不影响患者糖化血红蛋白定量。     

Calcineurin inhibitor-free immunosuppression in pediatric renal transplantation: a viable option?

The introduction, in the mid-1980s, of calcineurin inhibitors - namely ciclosporin (cyclosporine) and later tacrolimus - has significantly improved short-term renal graft survival by lowering acute rejection rates in both adult and pediatric kidney transplantation. Nonetheless, long-term transplant survival is still not satisfactory, with calcineurin inhibitor-induced chronic nephrotoxicity being one of the main causes of progressive nephron loss and declining renal transplant function. Hence, different immunosuppressant regimens have been proposed to avoid or ameliorate calcineurin inhibitor-induced nephrotoxicity. These comprise the use of non-depleting or depleting antibodies for calcineurin inhibitor minimization, calcineurin inhibitor avoidance, or calcineurin inhibitor withdrawal from mycophenolate mofetil-based immunosuppressant protocols. De novo use of a mammalian target of rapamycin (mTOR) inhibitor (sirolimus or everolimus) or conversion from a calcineurin inhibitor to an mTOR inhibitor may constitute another therapeutic option to avoid or reduce calcineurin inhibitor-induced nephrotoxicity. To date, complete calcineurin inhibitor avoidance seems to be inappropriate because other relatively potent immunosuppressant agents such as lymphocyte-depleting antibodies are needed for rejection prophylaxis, which are frequently accompanied by a higher incidence of infections and an unacceptably high acute rejection rate under calcineurin inhibitor avoidance. In some studies, calcineurin inhibitor withdrawal in adult and pediatric kidney allograft recipients with stable or declining transplant function has been associated with an amelioration of renal function; however, this is attained at the cost of a higher acute rejection rate in 10-20% of patients. It has been frequently stressed that conversion from a calcineurin inhibitor-based regimen to an mTOR inhibitor-based immunosuppressant regimen should be performed early (e.g. 3 or 6 months post-transplant) in patients with well-preserved renal transplant function without significant proteinuria in order to prevent, or at least limit, calcineurin inhibitor-induced tissue damage and provide long-term benefit. It should be borne in mind though that the use of an mTOR inhibitor carries the risk of potential adverse events such as aggravation of proteinuria, hyperlipidemia, myelosuppression, and hypergonadotropic hypogonadism. Even though everolimus may be better tolerated than sirolimus, studies on everolimus for calcineurin inhibitor-free immunosuppression in the pediatric kidney transplant patient population are lacking. At present, the safest therapeutic strategy for pediatric renal allograft recipients with chronic calcineurin inhibitor-induced nephrotoxicity appears to be a mycophenolate mofetil-based regimen with low-dose calcineurin inhibitor therapy and corticosteroids; available published data show that dual immunosuppression with mycophenolate mofetil and corticosteroids, as well as an mTOR inhibitor plus mycophenolate mofetil plus corticosteroid-based regimens, are associated with an increased risk of acute rejection episodes. In individual patients with evidenced chronic allograft dysfunction and over-immunosuppression leading to recurrent infections, dual maintenance immunosuppression with mycophenolate mofetil and corticosteroids may be appropriate. As stated in the annual report issued by the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Registry, currently the most popular immunosuppressant protocol consists of a calcineurin inhibitor combined with mycophenolate mofetil and corticosteroids: 59.1% and 53.2% of patients with a functioning graft receive a calcineurin inhibitor plus mycophenolate mofetil plus corticosteroid-based immunosuppression at 1 and 5 years post-transplant, respectively. 91.4% and 87.8% of patients are administered a calcineurin inhibitor-containing regimen 1 and/or 5 years after transplantation, respectively. Undoubtedly, the use of calcineurin inhibitor-free immunosuppressant regimens with or without antibody induction, plus an mTOR inhibitor and mycophenolate mofetil, requires more comprehensive long-term investigations to determine whether acceptable rejection rates and conservation of renal function can be achieved.     

达格列净对早期2型糖尿病肾病足细胞损伤及氧化应激的影响

目的探讨达格列净对早期2型糖尿病肾病足细胞损伤、氧化应激的影响。方法收集我院118例T2DN患者为研究对象,随机分为对照组和观察组,分别予以常规治疗及常规治疗+达格列净治疗12周,治疗前后检测并比较患者的血糖、糖化血红蛋白、尿白蛋白/肌酐比值、尿足细胞标记蛋白、超氧化物歧化酶、丙二醛的变化。结果治疗后,两组尿白蛋白/肌酐比值、尿足细胞标记蛋白、丙二醛均较治疗前降低,超氧化物歧化酶较治疗前升高,差异均有统计学意义(P<0.05);治疗后,观察组与对照组相比较,尿白蛋白/肌酐比值、足细胞标记蛋白、丙二醛下降更明显,超氧化物歧化酶升高更显著,差异均有统计学意义(P<0.05)。结论达格列净可能部分通过抑制糖尿病肾病患者体内的氧化应激反应减少足细胞损伤,进而降低蛋白尿。     

Treatment with a combined endothelin A/B-receptor antagonist does not prevent chronic renal allograft rejection in rats

A markedly increased expression of endothelin (ET)-1 has been observed in renal allografts with chronic rejection, one of the most common causes of kidney graft loss. In this study we investigated the effect of treatment with a combined ET-A/B-receptor antagonist on the course of chronic renal allograft rejection. Experiments were performed in the Fisher-to-Lewis rat model of chronic rejection. Lewis-to-Lewis isografts and uninephrectomized Lewis rats served as controls. Animals were treated with either the oral combined ET-A/B-receptor antagonist LU224332 (20 mg/kg/day) or vehicle. Animal survival, blood pressure, creatinine clearance, proteinuria, and urinary ET excretion were investigated for 24 weeks. Kidneys were removed for light-microscopic evaluation and immunohistochemical assessment of cell-surface markers. Treatment with LU224332 did not improve survival after 24 weeks (0.47 vs. 0.38; p > 0.05 by log-rank test), nor did it have an influence on blood pressure, creatinine clearance, or proteinuria. Combined ET-A/B-receptor blockade was associated with a reduction of expression of cell-surface markers for macrophages (EDI), T-cells (R73), and major histocompatibility complex (MHC) II (F17-23-2), but did not lead to an improvement of histologic changes of chronic allograft rejection. Our data show that blocking both ET-A- and -B receptors, in opposition to a previously published beneficial effect of selective ET-A blockade, does not prevent the progression of chronic renal allograft rejection and does not prolong survival in this model. Functional integrity of the ET-B receptor therefore seems to play an important role in the nephroprotection provided by selective ET-A-receptor antagonists in chronic renal allograft nephropathy.     

大剂量贝那普利治疗慢性肾病蛋白尿的临床研究

目的观察大剂量贝那普利治疗慢性肾病蛋白尿的，临床疗效及安全性。方法79例慢性肾病患者采用完全随机单盲法分成2组，贝那普利组完成观察35例，对照组完成观察32例，2组患者均给予激素或激素加环磷酰胺，或仅用潘生丁、保肾康等一般治疗。贝那普利组在上述治疗基础上加用贝那普利，开始以10mg／d，1周后加至20mg／d，2周后加至30～40mg／d，分2次口服，疗程24周。结果贝那普利组完全缓解19例，部分缓解10例，部分有效4例，无效2例，总有效率94．3％；对照组完全缓解14例，部分缓解9例，部分有效5例，无效4例，总有效率87．5％，2组有统计学意义（P〈0．05）。贝那普利组治疗前24h尿蛋白定量（2．67±1．32）g，治疗后为（0．67±0．58）g，差异有统计学意义（P〈0．01）；对照组治疗前24h尿蛋白定量（2．74±1．29）g，治疗后为（0．94±0．73）g，差异有统计学意义（P〈0．01）；2组治疗后尿蛋白定量比较差异有统计学意义（P〈0．05）。贝那普利组与对照组血压、血肌酐差异无统计学意义。结论大剂量贝那普利治疗慢性肾病有降低尿蛋白的作用，安全有效。