FUNCTIONAL RENAL-INSUFFICIENCY DURING LONG-TERM THERAPY WITH CAPTOPRIL AND ENALAPRIL IN SEVERE CHRONIC HEART-FAILURE
FUNCTIONAL RENAL-INSUFFICIENCY DURING LONG-TERM THERAPY WITH CAPTOPRIL AND ENALAPRIL IN SEVERE CHRONIC HEART-FAILURE
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DOI：
10.7326/0003-4819-106-3-346
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发表时间：
1987-03-01
影响因子：
39.2
通讯作者：
KESSLER, PD
中科院分区：
文献类型：
--
作者：
PACKER, M;WAI, HL;KESSLER, PD
对104例慢性心力衰竭患者分别用依那普利和卡托普利治疗后进行肾功能评价。70例患者显示肾功能无变化或改善（A组），34例患者出现功能性肾功能不全（B组）。B组患者在转换酶抑制前接受了较高剂量的呋塞米（p < 0.02），中心静脉压低于A组患者（p < 0.05）。经过1 ~ 3个月的转换酶抑制后，B组34例患者中有28例（82%）左室充盈压（小于15 mm Hg）或平均动脉压（小于60 mm Hg）过度降低，而A组70例患者中只有22例（31%）（p < 0.001）。在研究结束时，药物诱导的氮质血症解决后，减少利尿剂的剂量，尽管与卡托普利和依那普利治疗不变。因此，在心力衰竭中转化酶抑制后肾功能的恶化不是对治疗的毒性或免疫反应，而是由特定的血液动力学事件引起的，可以通过钠补充来改善。
Renal function was evaluated in 104 patients with severe chronic heart failure whom we treated with captopril or enalapril. Seventy patients showed no change or an improvement in renal function (group A), and 34 patients developed functional renal insufficiency (group B). Before converting-enzyme inhibition, group B patients received higher doses of furosemide (p < 0.02) and had lower central venous pressures (p < 0.05) than group A patients. After 1 to 3 months of converting-enzyme inhibition, an excessive reduction in left ventricular filling pressure (to less than 15 mm Hg) or mean arterial pressure (to less than 60 mm Hg) was noted in 28 of 34 (82%) patients in group B but in only 22 of 70 patients in group A (31%) (p < 0.001). At the end of the study, drug-induced azotemia resolved after a reduction in the dosage of diuretics, despite unaltered treatment with captopril and enalapril. Hence, the deterioration of renal function after converting-enzyme inhibition in heart failure is not a toxic or immunologic reaction to therapy but results from specific hemodynamic events that can be ameliorated by sodium repletion.