【摘要】 目的　探讨血管紧张素Ⅱ受体阻断剂 (ATRA)和血管紧张素转换酶抑制剂 (ACEI)对原发性高血压 (EH)所致的肾小球滤过功能和肾小管重吸收功能损害的保护作用。方法　以科素亚 (5 0mg/d )和卡托普利 (75mg/d )口服给药 ,疗程分为 4周和 6个月 2组 ,实验前后分别测定血清肌酐 (Cr)、每分钟内生肌酐清除率 (CCr)、尿素氮 (BUN)和2 4小时尿总蛋白、白蛋白、α1微球蛋白 (α1MG)和 β2 微球蛋白 (β2 MG)的排泄率。结果　入选患者治疗前血Cr、BUN无明显升高 ,患者 2 4小时尿总蛋白、白蛋白、α1微球蛋白和 β2 微球蛋白的排泄均有增加。4周治疗后 ,科素亚和卡托普利均能显著减少总尿蛋白、白蛋白、α1MG、β2 MG的排泄 ,Cr、CCr、BUN水平同治疗前相当。6个月治疗后 ,卡托普利组CCr较治疗前降低、尿白蛋白排泄与治疗前无显著差异 ,科素亚组仍能维持治疗前CCr水平且尿白蛋白排泄低于治疗前。科素亚还能显著增加尿钠的排泄。结论　EH肾损害 ,微蛋白尿的出现先于血Cr和BUN的升高 ,肾功能损害早期肾小球滤过功能和肾小管重吸收功能均受累 ,科素亚和卡托普利通过阻断肾素—血管紧张素系统均可减轻和延缓高血压引起的肾功能损害 ,科素亚长期疗效优于卡托普利更多还原

【Abstract】 Objective To investigate the protective effects of angiotensin Ⅱ receptor antagonist and angiotensin converting enzyme inhibitor on the renal injury in essential hypertension patients. Methods After the treatment with losartan (50mg/d) and captopril (75mg/d) for 4 weeks and 6 months, the serum creatinine (Cr), blood urea nitrogen(BUN), endogenous creatinine clearance rate (CCr), 24 h urine protein ( total urine protein, albumin, α 1 microglobulin and β 2 microglobulin) excretion, urine sodium and potassium were measured. Results In the EH patients, with normal Cr , CCr and BUN, the 24h total urine protein, albumin, α 1 microglobulin and β 2 microglobulin excretion were significantly higher comparing with control. Both losartan and captopril treatments decreased total urine protein and albumin, α 1 microglobulin and β 2 microglobulin urine excretion after 4 weeks treatment. After 6 months, in captopril group CCr was decreased and no differences of urine albumin was found before and after treatment, while the effect of losartan were remained as that of 4 weeks treatment. Losartan increased sodium excretion significantly. Conclusion A small amount of urine protein, which was detected before the increases of serum Cr, indicated the occurrence of early stage pathological damage of renal due to EH.\ Both the filtration and tubular reabsorption function damage were involved. Losartan and captopril can improve renal function effectively, and losartan seems to have better long term efficacy.更多还原