Long-term treatment by ACE inhibitors and angiotensin receptor blockers in children with Alport syndrome
Long-term treatment by ACE inhibitors and angiotensin receptor blockers in children with Alport syndrome
复制标题
ACE抑制剂和血管紧张素受体阻滞剂长期治疗阿尔波特综合征患儿
DOI：
10.1007/s00467-015-3184-5
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发表时间：
2016-01-01
影响因子：
3
通讯作者：
Yu, Lixia
中科院分区：
文献类型：
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作者：
Zhang, Yanqin;Wang, Fang;Yu, Lixia
本研究的目的是分析血管紧张素转换酶抑制剂（ACEi）和ACEi +血管紧张素受体阻滞剂（ARB）治疗Alport综合征（AS）儿童的长期疗效和安全性。结果AS患儿治疗开始时的平均年龄为8.6 ± 4.1（范围1.5-16.3）岁。平均随访时间为2.5 ± 1.8（范围0.5-7.8）年。为了进行分析，我们根据治疗前的蛋白尿水平将儿童分为三组，分别为<25、25-50和≥50 mg/kg/d;治疗1年后，每组的蛋白尿分别从11.0 mg/kg/d降至9.7 mg/kg/d、从34.6 mg/kg/d降至15.2 mg/kg/d和从73.0 mg/kg/d降至50.0 mg/kg/d。蛋白尿在治疗的前2年内显着减少，并在治疗的第3年至第5年保持稳定。在治疗1年后，ACEi和ACEi + ARB治疗对重度或轻度突变患者的抗蛋白尿作用无统计学显著差异。五名儿童停止ACEi + ARB治疗由于肌酐clearance.ConclusionOur研究结果表明，早期和长期ACEi和ARB治疗儿童AS是有效的，耐受性良好。ACEi和ARB的抗蛋白尿作用在COL 4An基因突变严重和不太严重的儿童中具有同等价值。
BackgroundThe aim of this study was to analyze the long-term efficacy and safety of angiotensin-converting enzyme inhibitor (ACEi) and ACEi + angiotensin receptor blocker (ARB) treatments in a cohort of children with Alport syndrome (AS).MethodsThis was a respective review of 79 Chinese children with AS who received ACEi alone or combined ACEi + ARB therapy.ResultsThe mean age of the pediatric patients with AS at onset of treatment was 8.6 ± 4.1 (range 1.5–16.3) years. The mean duration of follow-up was 2.5 ± 1.8 (range 0.5–7.8) years. For analysis, we separated the children into three groups according to proteinuria level before treatment, namely, <25, 25–50, and ≥50 mg/kg/day, respectively; after 1 year of treatment the proteinuria had decreased from 11.0 to 9.7 mg/kg/day, from 34.6 to 15.2 mg/kg/day, and from 73.0 to 50.0 mg/kg/day in each group, respectively. Proteinuria decreased significantly during the first 2 years of treatment and was stable from the third to fifth years of treatment. There was no statistically significant difference in the antiproteinuric effect of the ACEi and ACEi + ARB treatments in patients with severe or less severe mutations after 1 year of therapy. Five children stopped the ACEi + ARB treatment due to a decline in creatinine clearance.ConclusionOur findings demonstrate that early and long-term ACEi and ARB treatments in children with AS is efficient and well tolerated. The antiproteinuric effect of ACEi and ARB is of equal value in children with severe and less severe mutations in theCOL4Angene.