Treatment of IgA nephropathy with ACE inhibitors:: A Randomized and controlled trial
Treatment of IgA nephropathy with ACE inhibitors:: A Randomized and controlled trial
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DOI：
10.1097/01.asn.0000068460.37369.dc
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发表时间：
2003-06-01
影响因子：
13.6
通讯作者：
Hernández, E
中科院分区：
文献类型：
--
作者：
Praga, M;Gutiérrez, E;Hernández, E
一些回顾性研究表明，血管紧张素转换酶（ACE）抑制剂对伊加肾病（IgAN）的进展有有益的影响，但缺乏前瞻性和对照研究证明这种影响。44例经活检证实的IgAN患者，蛋白尿大于或等于0.5 g/d，血清肌酐（SCr）小于或等于1.5 mg/dl，随机分为依那普利组（n = 23）和对照组（n = 21），对照组用ACE抑制剂以外的降压药控制血压。主要结局是肾存活率，通过基线SCr增加50%估计。次要结局是末次访视时SCr > 1.5 mg/dl和蛋白尿的进展。依那普利治疗组和对照组的基线临床结果相似，随访期间血压控制无差异。依那普利组的平均随访时间为78 ± 37个月，对照组为74 ± 36个月。依那普利组3例（13%）达到主要终点，对照组12例（57%）达到主要终点（P < 0.05）。依那普利组4年后Kaplan-Meier生存率为100%，对照组为70%，依那普利组7年后Kaplan-Meier生存率为92%，对照组为55%，两组比较差异有统计学意义（P < 0.05）。依那普利组末次访视SCr > 1.5mg/dl者3例（13%），对照组11例（52%）（P < 0.05）。依那普利组尿蛋白明显减少，而对照组尿蛋白有增加的趋势（组间P < 0.001）。总之，ACE抑制剂可显著改善肾功能正常或中度降低的蛋白尿IgAN患者的肾存活率。
Some retrospective studies have suggested a beneficial influence of angiotensin-converting enzyme (ACE) inhibitors on the progression of IgA nephropathy (IgAN), but prospective and controlled studies demonstrating this effect are lacking. Forty-four patients with biopsy-proven IgAN, proteinuria greater than or equal to 0.5 g/d, and serum creatinine (SCr) less than or equal to 1.5 mg/dl were randomly assigned either to receive enalapril (n = 23) or to a control group (n = 21) in whom BP was controlled with antihypertensives other than ACE inhibitors. Primary outcome was renal survival estimated by a 50% increase in baseline SCr. Secondary outcomes were the presence of a SCr > 1.5 mg/dl at the last visit and the evolution of proteinuria. Baseline clinical findings were similar at baseline between enalapriltreated and control group, and there were no differences in BP control during follow-up. Mean follow-up was 78 +/- 37 mo in the enalapril group and 74 +/- 36 mo in the control group. Three patients (13%) in the enalapril group and 12 (57%) in the control group reached the primary end point (P < 0.05). Kaplan-Meier renal survival was significantly better in enalapril group than in control group: 100% versus 70% after 4 yr and 92% versus 55% after 7 yr (P < 0.05). Three patients in the enalapril group (13%) and 11 (52%) in the control group showed SCr > 1.5 mg/dl at the last visit (P < 0.05). Proteinuria significantly decreased in the enalapril group, whereas it tended to increase in the control group (P < 0.001 between groups). In conclusion, ACE inhibitors significantly improve renal survival in proteinuric IgAN with normal or moderately reduced renal function.