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目的:探讨血管紧张素转换酶抑制剂 (ACEI)依那普利 (enalapril)能否改善早期慢性移植肾肾病(CAN)患者的肾功能及其机制。 方法:对病理诊断为CANⅠ级的 23例患者(A组)于肾功能不全 2个月内开始服用依那普利(10mg/d),持续 1年以上,与同期内未服用ACEI的 25例CANⅠ级患者(B组)进行对比,比较两组患者 1年后肾功能、血和尿转化生长因子β1 (TGF β1 )水平(ELISA法测定);及治疗后移植肾组织中TGF β1mRNA表达量的变化(RT PCR法)。 结果:治疗 1年后,A组 15例(65 .2% )患者移植肾功能好转或稳定,B组中 4例(16. 0% )移植肾功能稳定,两组相比差异显著(P<0. 05)。观察终点时,A组肌酐清除率(Ccr)减损量[ (6 .6±5. 6 )vs(16 .3±9 .3)ml/min,P<0 01]、尿TGF β1 浓度(268 .2±82. 2vs458. 9±78 8pg/mg·Cr,P<0 .01)均明显低于B组;两组患者血TGF β1 浓度无明显差异。A组治疗后移植肾TGF β1mRNA表达量由 1 58±0 33降至 0 96±0 28(P<0 01)。 结论:依那普利能改善早期CAN患者的肾功能,抑制移植肾内TGF -β的表达。
Objective: To investigate whether enalapril, an angiotensin converting enzyme inhibitor (ACEI), can improve renal function and its mechanism in patients with early chronic allograft nephropathy (CAN). METHODS: Twenty-three patients (group A) with pathologically diagnosed CAN grade I started enalapril (10 mg / d) within 2 months of renal insufficiency for more than 1 year, compared with 25 patients who did not take ACEI during the same period The levels of TGF-β1 (TGFβ1) in the two groups were compared after one year. The levels of TGFβ1 mRNA in the renal allografts after treatment Change (RT PCR method). Results: After 1 year of treatment, the function of renal graft was improved or stabilized in 15 cases (65.2%) of group A, and 4 cases (16.0%) of group B had stable function of renal graft with significant difference between the two groups (P < 0. 05). At the end of the study, creatinine clearance (Ccr) in group A was significantly lower than that in group A [(6.6 ± 5.6 vs vs (16.3 ± 9.3) ml / min, P <0.01) .2 ± 82.2vs458.9 ± 78.8pg / mg · Cr, P <0.01) were significantly lower than those in group B. There was no significant difference in serum TGF-β1 concentrations between the two groups. In group A, the expression of TGFβ1 mRNA in renal allografts decreased from 158 ± 0 33 to 0 96 ± 0 28 (P <0.01). CONCLUSION: Enalapril can improve renal function and inhibit the expression of TGF-β in renal transplant recipients.