较高剂量的缬沙坦与贝那普利对IgA肾病的疗效对比

目的观察较大剂量的缬沙坦与贝那普利对IgA肾病的疗效和安全性。方法61例患者随机分为三组：缬沙坦组（对照1组）（n=20），服用缬沙坦160mg／d，贝那普利组（对照2组）（n=20）服用盐酸贝那普利20mg／d。联合组（治疗组）（n=21）服用缬沙坦160mg／d联合盐酸贝那普利20mg／d，疗程6个月，观察24h尿蛋白定量、血清肌肝、血压及血钾等变化及不良反应情况。结果6个月时三组24h尿蛋白定量均有明显下降，尤以治疗组明显，与其他两组比较差异显著（P〈0．05），总有效率分别为治疗组85．7％，对照1组45．0％，对照2组40．0％，均以治疗组最显著；与其他两组比较差异显著（P〈0．01），而对照1组与对照2组比较无明显差异（P〉0．05）。三组均能有效降低血压且副作用较轻，三组之间比较无显著性差异（P〉0．05）。结论较大剂量血管紧张素受体拮抗剂联合较大剂量转换酶抑制剂治疗IgA肾病安全有效，其疗效优于单用盐酸贝那普利或单用缬沙坦。

Comparison of therapeutic effect of higher-dose valsatan combined with higher dose of lotensin for IgA nephropathy

Objective To observe the effect and safety of higher-dose valsatan combined with benazepril on patients with IgA nephropathy.Methods Sixty-one patients were assigned to three groups at random.Patients took valsartan 160 mg/d in ARB group(n=20),or benazepril hydrochloride 20 mg/d in benazepril group(n=20),or valsartan 160 mg/d plus benazepril hydrochloride in combined therapy group(n=21) for six months.Urine protein,serum creatine,serum potassium,blood pressure and adverse effects were detected during the trial.Results After six months of therapy,24-hour proteinuria decreased,especially in therapy group(P<0.05).The total effective rate was 85.7% in therapy group,45.0% in first group,and 40.0% in the last one.There was no significant difference in the last two groups.Blood pressure in the three groups were decreased effectively with fewer side effects without obvious differences in the three groups.Conclusion It is safe and effective to treat IgA nephropathy with higher dose of valsatan combined with angiotensin converting enzyme inhibitor.It is superior to benazepril hydrochloride or valsatanalone.