缬沙坦治疗慢性移植肾肾病临床观察-东南大学学报医学版

缬沙坦治疗慢性移植肾肾病临床观察

单位：1.南京大学医学院附属鼓楼医院,肾脏科,江苏,南京,210008； 2.南京大学,生命科学院,江苏,南京,210093

分类号：R692

出版年·卷·期（页码）：2005·24·第三期（190-193）

摘要：

目的:观察缬沙坦治疗慢性移植肾肾病(CAN)的有效性及安全性.方法:将72例CAN患者分两组:治疗组41例予缬沙坦治疗,平均治疗(36.0±7.2)个月;对照组31例不予缬沙坦治疗.动态观察患者血肌酐(SCr)变化以及血压、血红蛋白、24 h尿蛋白定量等指标.结果:经过36、34个月的随访,两组患者分别有7例(17.1%)和11例(35.5%)发生初级终点事件,即SCr上升≥50%(P=0.10);治疗组联合终点事件(指患者死亡或返回透析)的发生率显著低于对照组(分别为9.8%和38.7%,P<0.01);且治疗组达到联合终点的时间也显著长于对照组(分别为53.9个月和41.5个月,P=0.02).治疗组患者尿蛋白排泄量明显降低(P=0.013).缬沙坦治疗的常见副作用是高钾血症和贫血.结论:缬沙坦治疗可有效降低移植肾功能丧失发生率,延缓移植肾功能衰竭的进展.

Objective To evaluate the safety and efficacy of the valsartan on renal function and proteinuira in patients with chronic allograft nephropathy (CAN). Methods Seventy-two patients with biopsyproven CAN were retrospectively analyzed who had more than 6 months followup in our center. Forty-one patients received valsartan therapy (therapy group) with a average therapy time of (36.0±7.2) months compared 31 patients without these agents (control group). The clinical data such as blood pressure, serum creatinine (SCr), hemoglobin level, quantification of proteinuria, etc were dynamically observed. The primary endpoint was a ≥50% sustained increase in SCr from baseline. Secondary endpoints included allograft failure (as defined by a return to dialysis) and the combined endpoint of death and dialysis.Results There were no significant different baseline of clinical characteristics between therapy group and control group at time of biopsy. With a mean followup time of 36, 34 months, 7 of 41 (17.1%) in therapy group vs 11 of 31 (35.5%) in control group reached the primary endpoint of >50% increase in SCr (P=0.10) respectively.Fewer patients in therapy group reached the combined secondary endpoint of allograft failure or death (9.8% vs 38.7%, P<0.01) with a significance; in addition, therapy group postponed the average time to the combined endpoint (53.9 vs 41.5 months,P=0.02). Noteworthily,the daily urine protein excreation fell from (2.14±2.60)g to (1.14±0.11)g (P=0.013). The common side effects in therapy group were transient hyperkalemia and anemia. Conclusion Valsartan therapy showes fairly satisfactory efficacy in slowing renal insufficiency as well as achieving significant survival benefit in the combined endpoint of allograft failure or death.

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