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目的观察长程应用ACEI联合ARB治疗慢性肾脏疾病的疗效和安全性。方法60例慢性肾脏疾病患者随机分为3组:ACEI组、ARB组和联合组,ACEI组接受贝那普利治疗, ARB组接受缬沙坦治疗,联合组接受贝那普利联合缬沙坦治疗。观察治疗后1、3、6、9和12个月的相关临床指标变化,并进行评价。结果3组患者经过12个月治疗后,24 h尿蛋白从(1．08±0．68)g降至(0．27±0．29)g,P<0．05;收缩压从(129±24)mm Hg降至(116±18)mm Hg (P<0．05);肾小球滤过率从(67．5±30．2) ml／min升至(69.3±34．6)ml／min(P>0．05);血钾变化不大(P>0．05);不良反应轻微。3组相比,联合组有最强的减少尿蛋白和降低舒张压作用(P< 0．05),而在肾功能改善、血钾变化及不良反应方面,3组间差异无统计学意义(P>0．05)。结论长期联合治疗双重阻断RAS系统有更强地降低蛋白尿和舒张压作用,而不良反应轻微。
Objective To observe the efficacy and safety of long-term use of ACEI combined with ARB in the treatment of chronic kidney disease. Methods 60 patients with chronic kidney disease were randomly divided into 3 groups: ACEI group, ARB group and combination group, ACEI group received benazepril treatment, ARB group received valsartan treatment, the combination group received benazepril combined with valsartan treatment. The changes of related clinical indexes at 1, 3, 6, 9 and 12 months after treatment were observed and evaluated. Results After 12 months of treatment, urinary protein in 24 hours was decreased from (1.08 ± 0.68) g to (0.27 ± 0.29) g in 3 groups (P <0.05) ± 24 mm Hg to 116 ± 18 mm Hg (P <0.05). Glomerular filtration rate increased from (67.5 ± 30.2) ml / min to (69.3 ± 34.6) ml / min (P> 0.05); little change in serum potassium (P> 0.05); slight adverse reactions. Compared with the control group, the combination group had the strongest reduction of urinary protein and reduced diastolic pressure (P <0.05), while there was no significant difference in the improvement of renal function, changes of serum potassium and adverse reactions among the three groups P> 0.05). Conclusion Long-term combination treatment of dual-block RAS system has a greater reduction in proteinuria and diastolic pressure, with mild adverse reactions.