关键词: 血管紧张素转换酶抑制剂, 血管紧张素Ⅱ受体阻断剂, 蛋白尿, 血管紧张素原, 血浆肾素活性, 血管紧张素Ⅱ

Abstract:

ABSTRACT  Objective：To investigate the effect of angiotensin converting enzyme inhibitor(ACEI), angiotensin Ⅱ receptor blocker(ARB) and combined treatment on general and intrarenal renin-angiotensin system(RAS) in pants with chronic kidney disease(CKD). Methodology：Twenty-four CKD patients were randomly assigned to benazepril, valsartan or conmbined treatment group. During 8 weeks of benazepril treatment (20mg/d), valsartan treatment (160mg/d) or conmbined treatment (benazepril 10mg/d and valsartan 80mg/d), the blood pressure, serum creatinine, and proteinuria were detected, and the plasma renin activity (PRA), plasma and urinary angiotensinogen(AGT), angiotensin Ⅱ(Ang Ⅱ) and aldosterone were measured by RIA or ELISA. Results：After treatment of 8 weeks, the level of proteinuria [(0.61±0.25)g/24h vs (0.35±0.20)g/24h, P<0.05] and urinary AGT [(60.76±28.05) ng/ (mg Cr) vs (23.09±14.74) ng/ (mg Cr), P<0.05] was lower in benazepril group than that in baseline. In valsartan group, mean artery pressure was lower than baseline [(99.17±10.56)mmHg vs (84.63±9.33)mmHg, P<0.05] and PRA was higher than baseline[ (1.33±0.76) ng/(ml.h) vs （6.02±2.59）ng/(ml.h), P<0.01]. The primary end point was 87.5% in benazepril group, 12.5% in valsartan group and 62.5% in combined treatment group. Compared with valsartan, the primary end point was reduced by benazepril (P<0.05). After 8 weeks treatment, PRA [(3.20±1.25)ng/(ml.h) vs (6.02±2.59)ng/(ml.h), P<0.05] and plasma Ang Ⅱ [(53.32±11.13)pg/ml vs (105.61±59.49)pg/ml, P<0.05] of benazepril group were lower than those of valsartan group. Conclusion： Short-term treatment with benazepril can reduce intrarenal agiotensin Ⅱ activity and urinary protein in patients with CKD. Valsartan may elevate plasma renin activity and angiotensin Ⅱ more significantly than benazepril.

Key words: Angiotensin converting enzyme inhibitor, Angiotensin Ⅱ receptor blocker, Proteinuria, Angiotensinogen, Plasma renin activity, Angiotensin Ⅱ