螺内酯对慢性肾脏病患者尿蛋白和尿血管紧张素原的影响

摘要

Objective To investigate the effect of spironolactone on reducing the levels of proteinuria and urinary angiotensinogen(UAGT) in patients with non-diabetic chronic kidney disease(CKD). Methods 40 patients with non-diabetic CKD hospitalized in Jinhua Central Hospital from October 2013 to July 2014 were selected. The patients were randomly assigned to spironolactone group(n=20)and control group(n=20). Patients of spironolactone group received treatment with spironolactone dose 40mg/d. Observation time was 12 months,excretion of proteinuria and UAGT and renal function of the patients were observed in 1,3,6 and 12 months. Results No significant change in MAP level(P>0.05)was observed in the control group during the follow-up period. Mean arterial pressure(MAP)of patients received spironolactone decreased significantly after 12 months(P<0.05). But both of the groups achieved the target blood pressure(<140/90mmHg)during the treatment period. There were no significantly differences of the blood creatinine,estimated glomerular filtration rate(eGFR)and baseline levels between two groups after 6 months follow up(P>0.05). But the creatinine in the control group was significantly higher than that of the baseline after 12 months(P<0.05),the eGFR was significantly lower than the baseline(P<0.05). 6 months after the treatment,UAGT and proteinuria/creatinine(UP/Cr)showed a downward trend,the differences had statistical significance(P<0.05). The changes of UP/Cr and log(UAGT/Cr)were positively correlated 12 months after the spironolactone treatment,(r=0.447,P=0.048),there was no significant correlation between MAP(r=-0.288,P=0.219)and concentration of blood AGT(r=-0.058,P=0.808). Multiple linear regression analysis revealed that only Log(UAGT/Cr)change was associated with UP/Cr (r=0.124,P=0.035). Conclusion Spironolactone can protect the renal function by reducing the level of proteinuria and urinary angiotensinogen raw excretion in non diabetic patients with CKD.%目的 观察螺内酯降低非糖尿病性慢性肾脏病(CKD)患者尿蛋白和尿血管紧张素原(UAGT)水平的作用及效果.方法 2013年10月至2014年7月非糖尿病CKD患者40例.随机分为螺内酯组(n=20)和对照组(n=20).螺内酯组患者接受螺内酯治疗剂量40mg/d.分别观察患者1、3、6、12个月尿蛋白和UAGT的排泄水平及肾功能的变化.结果 对照组患者在随访期间,平均动脉压(MAP)水平无明显变化(P>0.05),而接受螺内酯治疗12个月后MAP显著降低(P<0.05).但两组在治疗期间均达到目标血压值(<140/90mmHg).随访6个月后,对照组和螺内酯组血肌酐浓度和估算肾小球滤过率(eGFR)与基线水平差异无统计学意义(P>0.05).但在12个月后,对照组中肌酐浓度显著高于基线水平(P<0.05),eGFR显著低于基线水平(P<0.05).螺内酯治疗6个月后,尿蛋白/肌酐(UP/Cr)、UAGT均呈下降趋势,与基线相比较差异有统计学意义(P<0.05).螺内酯治疗12个月后,UP/Cr的变化与Log(UAGT/Cr)呈正相关(r=0.447,P=0.048),与MAP(r=-0.288,P=0.219)及血AGT浓度(r=-0.058,P=0.808)无明显相关性.多元线性回归分析发现,Log(UAGT/Cr)与UP/Cr的变化相关(r=0.124,P=0.035).结论 在非糖尿病性慢性肾脏病患者中,螺内酯显著降低尿蛋白和尿血管紧张素原的排泄水平,从而发挥肾脏保护作用.