贵州医科大学学报

2018, v.43;No.210(03) 329-335

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螺内酯对1~3期慢性肾脏病患者尿蛋白、醛固酮及肌酐水平的影响
Effect of Spironolactone on Levels of Urine Protein,Aldosterone and Creatinine in Patients with 1~3 Stage Chronic Kidney Disease

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

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;

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DOI: 10.19367/j.cnki.1000-2707.2018.03.017

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