联合应用肾素-血管紧张素系统抑制剂对慢性肾脏疾病患者血压、蛋白尿及肾功能的影响

目的探讨慢性肾脏疾病患者联合应用肾素一血管紧张素系统抑制剂对其血压、蛋白尿及肾功能的影响。方法采用前瞻性研究方法，选择我院2012年1月至2013年6月收治的慢性肾脏病患者128例，随机分为A、B、C三组，A组41例，给予贝那普利治疗；B组42例，给予缬沙坦治疗；C组45例，给予贝那普利和缬沙坦联合治疗。观察三组患者治疗前后血压、24h尿蛋白、血尿素氮（BUN）、血肌酐（SCr）、内生肌酐清除率（Ccr）值等指标。结果三组收缩压和舒张压治疗后均明显低于治疗前（P〈0．05）；三组24h尿蛋白和血钾治疗后与治疗前比较，差异均具有统计学意义（P〈0．05）；C组治疗后24h尿蛋白为（0．41±0．05）g，低于A组的（0．67±0．11）g和B组的（o．64±o．08）g（P〈0．05）；三组Scr、Ccr和BUN治疗后与治疗前比较，差异均具有统计学意义（P〈0．05）；C组治疗后Scr和BUN分别为（71．69±3．32）μmol／L和（6．21±0．13）mmol／L，低于A组的（88．42±3．50）μmaol／L、（8．19±0．17）mmol／L和B组的（87．95±4．13）μmol／L、（7．92±O．11）mmol／L（P〈0．05）；C组治疗后Ccr为（86．35±3．30）ml/min，高于A组的（76．33±3．55）ml/min和B组的（75．87±3．62）ml/min，差异具有统计学意义（P〈O．05）。结论贝那普利和缬沙坦均可降低机体血压和尿蛋白，对肾脏有良好的保护作用，二者的联合应用可以更好地治疗或延缓慢性肾脏病的进展。

Influence of rennin-angiotensin system inhibitor on blood pressure,proteinuria and renal function of patients with chronic kidney disease.

Objective To explore the influence ofrenin-angiotensin system inhibitor on blood pressure, pro- teinuria and renal function of patients with chronic kidney disease. Methods By prospective study, 128 patients with chronic kidney disease were selected in our hospital from January 2012 to June 2013, which were randomly divided into group A, group B and group C. Group A （41 patients） was treated with Benner Pury, group B （42 patients） was given valsartan, and group C （45 patients） was given combination therapy by Benner Pury and valsartan. The blood pressure, 24 h urine protein, Blood urea nitrogen （BUN）, serum treatinine （SCr）, creatinine clearance rate （Ccr） before and after treatment were observed. Results The systolic and diastolic blood pressure of the three groups after treat- ment were significantly lower than those before treatment （P〈0.05）; 24 h urine protein and serum potassium of three groups after treatment were statistically different from those before treatment （P〈0.05）; 24 h urinary protein of group C after treatment was （0.41 ±0.05） g, significantly lower than that of group A （0.67±0.11） g] and group B （0.64±0.08） g], P〈0.05; Scr, Ccr and BUN of three groups showed statistically significant difference before and after treatment （P〈0.05）; After treatment, Scr and BUN of in group C were （71.69±3.32） μmol/L and （6.21 ±0. l 3） mmol/L, signifi- cantly lower than those of group A （88.42±3.50） μmol/L, （8.19±0.17） mmol/L] and group B （87.95±4.13） μmol/L, （7.92± 0.11） mmol/L], P〈0.05; Ccr of group C after treatment was （86.35±3.30） ml/min, significantly higher than that of group A （76.33±3.55） ml/min] and group B （75.87± 3.62） ml/min]P〈0.05. Conclusion Benner Pury and valsar- tan could reduce the body＇s blood pressure and urine protein, and had a good protective effect on the kidney. The com- bination of the two methods is a better treatment and can delay the progression of chronic kidney disease.