Long-term beneficial effect of ACE inhibition on diabetic nephropathy in normotensive type 1 diabetic patients
Long-term beneficial effect of ACE inhibition on diabetic nephropathy in normotensive type 1 diabetic patients
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DOI：
10.1046/j.1523-1755.2001.00790.x
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发表时间：
2001-07-01
影响因子：
19.6
通讯作者：
Hansen, HP
中科院分区：
文献类型：
--
作者：
Parving, HH;Hommel, E;Hansen, HP
背景本研究的目的是评估长期（8年）抑制血管紧张素转换酶（ACE）是否能保护血压正常的1型糖尿病合并糖尿病肾病患者的肾功能。我们对血压正常的1型糖尿病肾病患者进行了一项开放随机随访研究，其中15例接受或未接受卡托普利治疗（N = 17），每天两次（平均74例，范围12.5至125 mg/天）。主要观察指标为动脉血压、蛋白尿。和肾小球滤过率（GFR：Cr-51-EDTA血浆清除率。每年两次）。卡托普利组的动脉血压（mm Hg）在基线时保持恒定（平均值）。对照组从127/79（2/1）增加到137/84（5/2）（P <0. 05）。（一）.此外，17名对照受试者中有8名因患高血压而需要降压药物治疗。卡托普利组的白蛋白清除率分数（x10（-5））保持不变：基线[10.8（1.25）]，8年期间的几何平均值和反对数（SEM）1 [11.8（1.47）]。对照组13.3（1.23）~26.2（1.42）（P <0.05）。基线GFR几乎相同：卡托普利组和对照组分别为111（6）和115（4）mL/min/1.73 m（2）。分别GFR（mL/min/年）下降的中位（范围）速率在卡托普利组为1.7（10.7至-2.0），而对照组为2.8（17.7至-2.6）（P = NS）。卡托普利在抑制全身血压和蛋白尿升高方面的有益作用是持久的。在大多数糖尿病肾病患者中，如果通过ACE抑制剂的前瞻性治疗维持正常血压，或随着高血压的发展通过使用其他降压药物恢复正常血压，则GFR的损失是最小的。
Background. The purpose of this study was to assess whether long-term (8 years) inhibition of angiotensin-converting enzyme (ACE) protects kidney function in normotensive type 1 diabetic patients with diabetic nephropathy.Methods. We performed an open randomized follow-up study of normotensive type 1 diabetics with nephropathy either treated (N = 15) or not (N = 17) with captopril twice per day (average 74, range 12.5 to 125 mg/day). The main outcome measures were arterial blood pressure, albuminuria. and glomerular filtration rate (GFR: Cr-51-EDTA plasma clearance. twice yearly).Results. Arterial blood pressure (mm Hg) was kept constant in the captopril group, at baseline (mean. SEM), 128/75 (3/2) and during follow-up 129/77 (4/1) but increased significantly in the control group from 127/79 (2/1) to 137/84 (5/2) (P < ().()I). Furthermore, 8 out of the 17 control subjects required treatment with blood pressure-lowering drugs because they developed hypertension. The fractional albumin clearance (x10(-5)) remained unchanged in the captopril group: baseline [10.8 (1.25) geometric mean and antilog (SEM)1 during the eight years [11.8 (1.47)]. while a significant rise occurred in control patients: 13.3 (1.23) to 26.2 (1.42) (P < 0.05). Baseline GFR was nearly identical: 111 (6) and 115 (4) mL/min/1.73 m(2) in the captopril and control group. respectively. The median (range) rate of decline in GFR (mL/min/year) was 1.7 (10.7 to - 2.0) in the captopril group versus 2.8 (17.7 to -2.6) in the control group (P = NS).Conclusions. The beneficial effect of captopril in arresting the rise in systemic blood pressure and albuminuria is long lasting. A loss in GFR is minimal in most patients with diabetic nephropathy if normotension is sustained by prospective treatment with ACE inhibitors or restored by implementation of other antihypertensive medications with the development of hypertension.