大剂量ARB对肾移植后蛋白尿治疗作用的临床研究

目的观察大剂量ARB对肾移植后蛋白尿的疗效及安全性。方法83例肾移植后蛋白尿患者,分为治疗组50例(采用2~4倍剂量ARB治疗)和对照组33例(不使用ARB治疗),观察不同治疗时间两组患者24h尿蛋白、血肌酐、血生化、血压、远期人/肾生存率及药物不良反应。结果治疗组24h尿蛋白排出显著低于对照组;治疗组血肌酐倍增时间、进展到移植肾功能衰竭或死亡的时间显著高于对照组〔(34.42±12.56)个月与(17.51±10.26)个月,(38.12±22.51)个月与(24.25±13.56)个月〕;治疗组出现2例血钾升高,4例低血压。结论大剂量ARB可有效控制肾移植后蛋白尿,提高移植患者人/肾远期存活率,使用安全有效。

High-dose angiotensin receptor blocker for the treatment of proteinuria in renal transplant recipients

Objective To evaluate therapeutic effects and security of high-dose ARB angiotensin receptor blocker for the treatment of proteinuria in renal transplant recipients.Methods 83 cases of renal transplant recipients with persistent proteinuria (>1.0g/d) were enrolled,with 50 cases in ARB group (treated with 2-4 times dosage of ARB) and others in control group( treated without ARB).Urine protein loss,serum creatinine and potassium,blood pressure,serum creatinine double time and time to reach end-stage renal failure were observed.Results ARB treatment markedly decreased urine protein loss.Serum creatinine double time and time for patients to reach end-stage renal failure or death were markedly prolonged in ARB group,with 2 cases of hyperkalemia and 4 cases of hypotension.Conclusion High-dose angiotensin receptor blocker can effectively be used for the treatment of proteinuria in renal transplant recipients,with increase allograft/patient life span and high security.