短期使用苯那普利对肾小球滤过膜通透性及近端小管功能的影响

摘要

目的：研究肾小球滤过膜对不同分子量蛋白质通透性能对苯那普利短期治疗的反应性。方法：根据聚丙烯酰胺凝胶电泳和24h尿蛋白定量，计算出大分子量和中分子量尿蛋白排泄量。连续口服苯那普利10mg*d-1,共两天，测定用药前后24h尿蛋白总量、尿蛋白圆盘电泳、平均动脉血压、钠离子滤过排泄分数、纯水清除率、血肌酐、内生肌酐清除率、血电解质、肝功能等。结果：用药前后大分子尿蛋白(1.15±0.89g/24h、0.84±0.74g/h,P<0.01)、平均动脉血压(14.19±1.96kPa、12.76±1.12kPa，P<0.01）明显减少，24h尿蛋白总量(3.16±2.24g/24h、2.83±2.27g/24h，P>0.05)、中分子尿蛋白(1.72±1.22g/24h、1.62±1.47g/24h，P>0.05）减少无显著性。血清肌酐、内生肌酐清除率、电解质、血浆总蛋白、白蛋白、钠离子滤过排泄分数、纯水清除率无明显改变。结论：短期使用苯那普利可改善肾小球滤过膜对大分子蛋白的通透性，对钠滤过排泄分数和纯水清除率无明显影响。%Objective: The effects of glumerular barrier permselectivity to different molecule protein were studied in patients with glomerularnephritis after administrating of Benazepril in short period. Methods: The large molecule proteinuria (LP, >100000d) and middle molecule protienuria (MP, 50000d-100000d) were calculated according to their 24 hours urinary protein excretion and polyacrylamide gel electrophoresis. LP,MP,Mean arterial pressure (MAP), filtration excretion of sodium (FENa),free water clearance rate (CH2O) , endogenous creatinine clearance (Ccr), electrolyte, renal function, liver function were measured before and after administration of 10mg benazipril orally in two consecutive days.Results: After treatment, LP,MAP were significantly reduced(0.84±0.74g/h versus 1.15±0.89g/24h, P<0.01; 12.76±1.12kpa versus 14.19±1.96kpa, P<0.01, respectively) but total proteinuria (TP),MP decreased insignificantly (2.83±2.27g/24h versus 3.16±2.24g/24h, P>0.05;1.62±1.47g/24h versus 1.72±1.22,P>0.05). The effects on Ccr, electrolyte, renal function, liver function, serum albumin, FENa,CH2O were insignificant. Conclusions: It is demonstrated that administrating Benazepril in short period reduced the amount of proteinuria, improved the glumerular filtration membrane permselectivity to LP in patients with glomerulonephritis.No effect of Benazepril on FENa and CH20 was observed.