CAJ | 학술논문

目的研究非糖尿病慢性肾脏病(CKD)患者醛固酮逃逸的发生率及相关影响因素.方法选择非糖尿病CKD患者144例,予血管紧张素Ⅱ受体拮抗剂(ARB)或ARB联合血管紧张素转化酶抑制剂(ACEI)治疗12个月,根据治疗前后醛固酮浓度的变化,确定是否发生醛固酮逃逸.结果肾素-血管紧张素-醛固酮系统抑制剂(RASI)治疗6个月时醛固酮逃逸的发生率为14.58％,治疗12个月时醛固酮逃逸的发生率显著升高(27.08％,P=0.009).以治疗前水平为基线值,醛固酮逃逸的患者24 h尿蛋白量与基线值的差值显著小于未发生逃逸的患者(P＜0.05),eGFR的差值也显著大于未发生逃逸的患者(P＜0.01).尿蛋白基线值(OR=3.643,P=0.073)、eGFR基线值(OR=0.980,P=0.025)与RASI治疗12个月醛固酮逃逸的发生相关；eGFR基线值(OR=0.980,P=0.025)是醛固酮逃逸的独立预测因素.结论部分非糖尿病CKD患者在RASI治疗后出现醛固酮逃逸,醛固酮逃逸的发生率随RASI治疗时间延长呈升高趋势.eGFR基线值是醛固酮逃逸发生的独立预测因素.醛固酮逃逸可能影响RASI减少蛋白尿和保护肾功能的治疗效果.
목적 연구비당뇨병만성신장병(CKD)환자철고동도일적발생솔급상관영향인소.방법 선택비당뇨병CKD환자144례,여혈관긴장소Ⅱ수체길항제(ARB)혹ARB연합혈관긴장소전화매억제제(ACEI)치료12개월,근거치료전후철고동농도적변화,학정시부발생철고동도일.결과 신소-혈관긴장소-철고동계통억제제(RASI)치료6개월시철고동도일적발생솔위14.58％,치료12개월시철고동도일적발생솔현저승고(27.08％,P=0.009).이치료전수평위기선치,철고동도일적환자24 h뇨단백량여기선치적차치현저소우미발생도일적환자(P＜0.05),eGFR적차치야현저대우미발생도일적환자(P＜0.01).뇨단백기선치(OR=3.643,P=0.073)、eGFR기선치(OR=0.980,P=0.025)여RASI치료12개월철고동도일적발생상관；eGFR기선치(OR=0.980,P=0.025)시철고동도일적독립예측인소.결론 부분비당뇨병CKD환자재RASI치료후출현철고동도일,철고동도일적발생솔수RASI치료시간연장정승고추세.eGFR기선치시철고동도일발생적독립예측인소.철고동도일가능영향RASI감소단백뇨화보호신공능적치료효과.
Objective To investigate the incidence and influencing factors of aldosterone breakthrough during therapy with angiotensin Ⅱ receptor blockers (ARB) alone,or combined with angiotensin-converting enzyme inhibitors (ACEI) in Chinese patients with non-diabetic nephropathy.Methods A total of 144 patients with non-diabetic nephropathy were treated with ARB or combination therapy of ACEI and ARB for a mean follow-up period of 12 months.Aldosterone breakthrough was determined according to the change of plasma aldosterone concentration before and after treatment during 6-month and 12-month ACEI/ARB treatment.Results In 6 months,aldosterone breakthrough occurred in 21 patients,corresponding to 14.58％,while in 12 months,occurred in 39 patients,corresponding to 27.08％.Although the overall urinary protein excretion (UPE) decreased after treatment in both groups (P＜0.05),non-breakthrough group had a more remarkable reduction in UPE (P＜0.05).Univariate Logistic regression demonstrated that risk factors of aldosterone breakthrough included pre-treatment values of UPE (OR=3.643,P=0.073) and eGFR (OR=0.980,P=0.025).Multivariate Logistic model revealed pre-treatment values of eGFR was positively associated with aldosterone breakthrough (OR=0.980,P=0.025).Conclusions The incidence of the aldosterone breakthrough increases with duration of treatment.The patients with aldosterone breathrough have higher level of UPE,and enhanced decline in eGFR.Pretreatment value of eGFR is independent risk factor of aldosterone breakthrough.