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題名 | Additive Effect of Combination Therapy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blocker on Proteinuria in Chronic Kidney Disease Patients=血管張力素轉換酶抑制劑和血管張力素受器阻斷劑的組合療法使用在慢性腎臟病的好處 |
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作者姓名(中文) | 張立群; 楊垂勳; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷期 | 23:2 2009.06[民98.06] |
頁次 | 頁84-89+126 |
分類號 | 415.74 |
關鍵詞 | 組合療法; 血管張力素轉換酶抑制劑; 血管張力素受器阻斷劑; 蛋白尿; 慢性腎臟病; Combination therapy; ACEI; ARB; Proteinuria; Chronic kidney disease; Renin-angiotensin-aldosterone system; |
語文 | 英文(English) |
中文摘要 | 背景:血管張力素轉換酶抑制劑和血管張力素受器阻斷劑常使用在慢性腎臟病的病人身上企圖來降低蛋白尿,甚至阻止腎功能的惡化。但血管張力素轉換酶抑制劑和血管張力素受器阻斷劑的組合療法使用在華人身上是否比單用血管張力素轉換酶抑制劑或血管張力素受器阻斷劑有更好的效果仍待證明。方法:在19個慢性腎臟病的病人身上,我們比較組合療法和單用血管張力素轉換酶抑制劑或血管張力素受器阻斷劑的差別。慢性腎臟病定義為:非糖尿病組為血清肌酸酐在1.5mg/dl以上或每天尿蛋白在150mg以上;糖尿病組為每天尿蛋白在300mg以上。所有的病人都至少服用一種血管張力素受器阻斷劑(Irbesrtan 150mg, Telmisartan 40 mg,Valsartan 80 mg, Losartan 50 mg, Cardesartan 8 mg)或一種血管張力素轉換酶抑制劑(Ramipril 10 mg, Quinapril 10 mg, Cilazanril 2.5mg)三個月以上,然後處方一種血管張力素轉換酶抑制劑或血管張力素受器阻斷劑做為組合療往。我們觀察3個月和6個月的效果。19個病人分為糖尿病組(n=11,年齡:64±12; 46~85)和非糖尿病組(n=8, 年齡:47.8±12; 29~67)。每次門診皆會記錄血壓、尿蛋白和尿肌酸酐的比值。統計分析使用Wilcoxon Signed Rank test。結果:在實驗期間,病人的腎功能和電解質沒有顯著的變化。在糖尿病組,尿蛋白和尿肌酸酐的比值在0個月為4.4±2.3,3個月為3.1±2.9(↓25.85%, P<0.05),6個月為2.4±2.6(↓39.89%, p<0.01);在非糖尿病組,尿蛋白和尿肌酸酐的比值在0個月為2.6±1.8,3個月為2.0±1.2(↓26.24%, p<0.05),6個月為1.9±1.9(↓30.13%, p<0.001)。組合療法沒有顯著降低血壓的效果。結論:血管張力素轉換酶抑制劑和血管張力素受器阻斷劑組合療法比單用療法提供了慢性腎臟病的病人更多降低蛋白尿的好處,效果和血壓的降低無關。蛋白尿在糖尿病組和非糖尿病組皆有顯著的降低。 |
英文摘要 | Background: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) were frequently prescribed in the case of chronic kidney disease (CKD) to reduce proteinuria and, if any, to retard the deterioration of renal function. It remains to be determined whether ACEI plus ARB provide more additional effects than either ACEI or ARD monotherapy in Chinese population with CKD. Methods: We observed the effects of combination therapy of ACEI plus ARB with either ACEI or ARB alone in 19 CKD patients. CKD was defined as serum Cr≥1.5 mg/dl or Upro≥150 mg/day in non-DM group or urine protein a 300 mg/day in DM group. All 19 patients were given one kind of ARE (Irbesartan 150 mg, Telmisartan 40 mg, Valsartan 80 mg, Losartan 50 mg, Cardesartan 8 mg) or ACEI (Ramipril 10 mg, Quinapril 10 mg, Cilazapril 2.5 mg) for at least 3 months and one kind of ACEI or ARE was added for combination therapy. We focused on the effect of combination therapy after first 3 and 6 months. Nineteen CKD patients were divided into two groups, that is, 11 in the diabetes mellitus (DM) group (age: 69.4±10, 46-85) and 8 in the non-DM group (age: 47.8±12, 29-67). Blood pressure, urine protein/ urine creatinine (Upro/Ucr) were recorded at each visit. Results: There were no significant changes in the renal function and electrolytes during this period. As shown in table] and figure 2, in the DM group, Upro/Ucr (mg/mg) showed 4.4±2.3, 3.1±2.9 (↓28.85%, p<0.05), and 2.4±2.6(↓39.89%, p<0.01) in 0,3, and 6 months, respectively. In the non-DM group, Upro/Ucr showed 2.6±1.8, 2.0±1.2 (↓22.87%, p<0.05), and 1.3±0.7(↓4.40.46%, p<0.05) in 0,3, and 6 months, respectively. Totally, Upro/Ucr showed 3.6±2.3, 2.6±2.6(↓26.24%, p<0.05), and 1.9±1.9 (↓30.13%, p<0.001) in 0,3, and 6 months, respectively. The lowering of blood pressure was not statistically significant among all patients. Conclusions: ACEI/ARB combination therapy provides additional beneficial effect on reducing proteinuria beyond controlling the blood pressure and its anti-proteinuric effects were significant in both DM and non-DM CKD patients. |
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