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目的探索氯沙坦治疗期间肾小球滤过率(eGFR)的初始下降是否产生长期肾功能下降减缓。方法 119例2型糖尿病肾病病人随机分到氯沙坦组或安慰剂组,分别接受氯沙坦100 mg或安慰剂,每日1次,随访27个月。结果治疗3个月氯沙坦组平均eGFR比安慰剂组有明显的下降,但此后其长期eGFR下降速率明显减缓。因观察到氯沙坦组急性eGFR改变的个体差异很大,按eGFR初始下降的程度再分成2亚组,即降低组和升高组(分别平均为-7.3,+3.2mL.min-1.1.73 m-2),与基线比较,初始eGFR下降组其长期下降速率明显高于初始升高组。但与3个月时比较,初始eGFR下降组其长期下降速率则明显低于初始升高组。结论用氯沙坦治疗期间急性eGFR下降越大,其长期eGFR下降速率则越慢。
Objective To explore whether the initial decline in glomerular filtration rate (eGFR) during losartan treatment may have a long-term decline in renal function. Methods A total of 119 patients with type 2 diabetic nephropathy were randomized to losartan or placebo to receive either losartan 100 mg or placebo once daily for 27 months. Results The mean eGFR in losartan group was significantly lower than that in placebo group after 3 months of treatment, but its long-term decline in eGFR rate was significantly slowed down after 3 months of treatment. Because of the observed differences in individuals with acute eGFR changes in the losartan group, they were subdivided into 2 subgroups according to the initial decline in eGFR, ie, decreased and elevated groups (mean -7.3, + 3.2 mL.min -1.1, respectively). 73 m-2). Compared with the baseline, the long-term decline rate of the initial eGFR decline group was significantly higher than the initial increase group. However, compared with 3 months, the long-term decline rate of the initial eGFR decline group was significantly lower than the initial increase group. Conclusions The greater the decrease of acute eGFR during losartan treatment, the slower the decline rate of long-term eGFR.