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目的明确血管紧张素Ⅱ受体拮抗剂洛沙坦能否改善慢性移植物肾病患者的肾功能。方法2001年8月至2003年4月期间,对病理诊断为慢性移植物肾病(Ⅰ级)肾功不全的24例患者(组Ⅰ)使用洛沙坦治疗1年以上,与同期内未使用洛沙坦的27例慢性移植物肾病患者(组Ⅱ)进行对比,比较两组的肾功能、血和尿转移生长因子-β1(TGF-β1)浓度及使用洛沙坦的不良反应等。结果治疗1年后,组Ⅰ有15例(62.5%)患者移植肾功能得以好转或不再继续恶化,而组Ⅱ除6例(22.2%)移植肾功能维持在原有水平外,其他患者肾功能均进行性恶化。组Ⅰ血和尿TGF-β1浓度及肾功能损失量均明显低于组Ⅱ,使用洛沙坦无不良反应发生。结论洛沙坦能改善部分慢性移植物肾病患者的肾功能,其药理作用可能与降低移植肾内TGF-β1的分泌有关。
Objective To determine if losartan, an angiotensin Ⅱ receptor antagonist, ameliorates renal function in patients with chronic allograft nephropathy. Methods From August 2001 to April 2003, 24 patients with pathologically diagnosed chronic graft-versus-kidney disease (grade Ⅰ) with renal insufficiency (group Ⅰ) were treated with losartan for more than 1 year, compared with those who did not use los Twenty-seven patients with chronic graft-versus-nephropathy (SD) were compared. Renal function, serum and urinary TGF-β1 levels and the adverse reactions of losartan were compared between the two groups. Results After 1 year of treatment, renal function of the group Ⅰ improved or no longer continue to worsen in 15 cases (62.5%) in group Ⅰ, and 6 cases (22.2%) of group Ⅱ maintained renal function outside the original level. Other patients’ renal function Progressive deterioration. Group Ⅰ blood and urine TGF-β1 concentration and renal dysfunction were significantly lower than group Ⅱ, no adverse reactions with losartan. Conclusion Losartan can improve renal function in patients with chronic allograft nephropathy. The pharmacological effects of losartan may be related to the decrease of TGF-β1 secretion in transplanted kidneys.