董晓;曾家顺;
DONG Xiao;ZENG Jiashun;Guizhou Medical University;Affilited Hosptial of Guizhou Medical University;

• 1:贵州医科大学
• 2:贵州医科大学附院

摘要(Abstract)：

目的:探讨螺内酯对1~3期慢性肾脏病(CKD)患者尿蛋白、醛固酮及肌酐水平的影响。方法:80例使用血管紧张素转化酶抑制剂(ACEI)和(或)血管紧张素受体拮抗剂(ARB)的1~3期CKD患者随机分为4组,A组给予贝那普利,B组给予贝那普利及厄贝沙坦,C组给予贝那普利及螺内酯,D组给予贝那普利、厄贝沙坦及螺内酯组,比较4组患者治疗前及治疗第2、4、6月时尿蛋白下降百分比、血浆醛固酮、血肌酐、血压、血钾水平,分析治疗前及治疗后6月时24 h尿蛋白与醛固酮的相关性。结果:治疗后第4、6月,C、D组24 h尿蛋白下降百分比高于A、B组,血浆醛固酮水平低于A、B组,差异有统计学意义(P<0.05);各时点各组CKD患者血肌酐、血压、血钾水平差异无统计学意义(P>0.05);尿蛋白与血浆醛固酮水平呈正相关(P<0.05)。结论:在ACEI和(或)ARB治疗基础上加用螺内酯可减轻1~3期CKD患者尿蛋白,可能延缓CKD进展。
Objective: To investigate the effect of spironolactone on the levels of urine protein,aldosterone and creatinine in patients with 1 ~ 3 stage chronic kidney disease( CKD). Method: Eighty patients with early CKD who cured by ACEI or ARB were divided them into 4 groups randomly,group A was treated with benazepril,group B was given benazepril and irbesartan,C group was given benazepril and spironolactone,group D was given benazepril,irbesartan and spironolactone. The percentage of urine protein decrease,plasma aldosterone,blood creatinine,blood pressure and blood potassium level were compared between the 4 groups before treatment and second,fourth,sixth months after treatment. The correlation between 24 h urine protein and aldosterone before and sixth months after treatment was analyzed. Results: After treatment for 4 and 6 months,the percentage of urine protein decrease in groups C and D was higher than that of groups A and B,plasma aldosterone levels were lower than groups A and B,the difference was statistically significant( P < 0. 05); no statistical difference was found in serum creatinine,blood pressure,blood potassium levels at each time point in each group of CKD patients( P > 0. 05); urinary protein was positively correlated with the level of plasma aldosterone( P < 0. 05). Conclusions: In CKD 1-3 stage patients,adding spironolactone can reduce urinary protein on the basis of ACEI and ARB,and delay the progress of CKD.

关键词(KeyWords)： 螺内酯;慢性肾脏病;24 h尿蛋白;醛固酮;血肌酐;血钾
spironolactone;chronic kidney disease;24 h urinary protein;aldosterone;serum creatinine;serum potassium

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫生计生委科技术基金项目(gzwjkj2014-2-108)

作者(Author): 董晓;曾家顺;
DONG Xiao;ZENG Jiashun;Guizhou Medical University;Affilited Hosptial of Guizhou Medical University;

Email:

DOI: 10.19367/j.cnki.1000-2707.2018.03.017

参考文献(References)：

• [1]HOSTETTER T H,ROSENBERG M E,Ibrahim H N,et al.Aldosterone in renal disease[J].Current Opinion in Nephrology&Hypertension,2001,10(1):105.
• [2]PITT B.“Escape”of aldosterone production in patients with left ventricular dysfunction treated with an angiotensin converting enzyme inhibitor:Implications for therapy[J].Cardiovascular Drugs&Therapy,1995,9(1):145-149.
• [3]TSUKAMOTO Y.Principles and methodology of K/DOQI clinical guidelines[J].Clin Calcium,2004,14(5):689-692.
• [4]WANG H.Prevalence of chronic kidney disease in ChinaAuthor's reply[J].Lancet,2012,380(9838):214-216.
• [5]KATO S,MARUYAMA S,MAKINO H,et al.Anti-albuminuric effects of spironolactone in patients with type 2diabetic nephropathy:a multicenter,randomized clinical trial.[J].Clinical&Experimental Nephrology,2015,19(6):1098-1106.
• [6]PARVING H H,PERSSON F,LEWIS J B,et al.The combination of aliskiren,a direct renin inhibitor,and losartan in patients with type 2 diabetes and nephropathy[J].N Engl J Med,2008,6(5):358.
• [7]柯箫韵,喻格书,袁慧中,等.螺内酯联合缬沙坦在早期糖尿病肾病治疗中的作用[J].重庆医学,2013,42(11):1252-1253.
• [8]万青松,谢红萍,杨波.安体舒通联合氢氯噻嗪对2型糖尿病肾病蛋白尿的影响[J].中国现代医学杂志,2015,25(5):57-60.
• [9]WILMER W A,ROVIN B H,HEBERT C J,et al.Management of glomerular proteinuria:a commentary[J].Journal of the American Society of Nephrology,2003,14(12):3217.
• [10]ATKINS R C,BRIGANTI E M,LEWIS J B,et al.Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy[J].American Journal of Kidney Diseases the Official Journal of the National Kidney Foundation,2005,45(2):281-287.
• [11]CHRYSOSTOMOU A,PEDAGOGOS E,MACGREGOR L,et al.Double-blind,placebo-controlled study on the effect of the aldosterone receptor antagonist spironolactone in patients who have persistent proteinuria and are on long-term angiotensin-converting enzyme inhibitor therapy,with or without an angiotensin II R[J].Clinical Journal of the American Society of Nephrology Cjasn,2006,1(2):256.
• [12]ESNAULT V L,EKHLAS A,DELCROIX C,et al.Diuretic and enhanced sodium restriction results in improved antiproteinuric response to RAS blocking agents[J].Journal of the American Society of Nephrology Jasn,2005,16(2):474.
• [13]BUTER H,HEMMELDER M,NAVIS G,et al.The blunting of the antiproteinuric efficacy of ACE inhibition by high sodium intake can be restored by hydrochlorothiazide[J].Nephrology,Dialysis,Transplantation:Official Publication of the European Dialysis and Transplant Association-European Renal Association,1998,13(7):1682.
• [14]WRENGER E,MOESENTHIN M M,TOBIAS WELTE J C F,et al.Interaction of spironolactone with ACE inhibitors or angiotensin receptor blockers:analysis of 44 cases[J].Bmj,2003,327(7407):147.
• [15]LANGOTE A,HIREMATH S,RUZICKA M,et al.Spironolactone is effective in treating hypokalemia among peritoneal dialysis patients[J].Plos One,2017,12(11):e0187269.

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