高剂量氯沙坦与IgA肾炎中ACE基因多态性的关系。

IF 3.5 Q1 EDUCATION & EDUCATIONAL RESEARCH
Genomic medicine Pub Date : 2008-12-01 Epub Date: 2009-03-25 DOI:10.1007/s11568-009-9030-8
Keng-Thye Woo, Choong-Meng Chan, Hui-Lin Choong, Han-Kim Tan, Marjorie Foo, Evan J C Lee, Chorh-Chuan Tan, Grace S L Lee, Seng-Hoe Tan, A Vathsala, Cheng-Hong Lim, Gilbert S C Chiang, Stephanie Fook-Chong, Zhao Yi, H B Tan, Kok-Seng Wong
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引用次数: 8

摘要

背景/目的几项研究报道了ACE基因对ACEI/ARB治疗影响的不同结果。大剂量ARB的疗效及其对ACE基因的影响尚未探讨。这是一项为期6年的IgA肾炎随机试验,比较高剂量ARB(氯沙坦200 mg/天)与正常剂量ARB(氯沙坦100 mg/天)、正常剂量ACEI (20 mg/天)和低剂量ACEI (10 mg/天)。结果高剂量ARB组患者蛋白尿1.0 +/- 0.8 g/d,显著低于其他组的1.7 +/- 1.0 g/d (P = 0.0005)。高剂量ARB组eGFR损失为0.7 ml min(-1)年(-1),而其他三组为3.2-3.5 ml min(-1)年(-1)(P = 0.0005)。与其他三组相比,高剂量ARB组eGFR改善的患者更多(P < 0.001)。与三种ACE基因型DD、ID和II患者比较,三组患者对治疗均有良好的反应,蛋白尿减少(P < 0.002)。只有低剂量ACEI (10 mg/d)患者的ESRF升高(P = 0.037)。结论与正常剂量ARB和ACEI相比,大剂量ARB在降低蛋白尿和维持肾功能方面更有效,并消除了ACE基因多态性对肾脏生存的基因组影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
High dose Losartan and ACE gene polymorphism in IgA nephritis.

Background/aims Several studies have reported varying results of the influence of ACE gene on ACEI/ARB therapy. The efficacy of high dose ARB and its influence on ACE gene have not been explored. This is a 6 year randomised trial in IgA nephritis comparing high dose ARB (Losartan 200 mg/day) with normal dose ARB (Losartan 100 mg/day), normal dose ACEI (20 mg/day) and low dose ACEI (10 mg/day). Results Patients on high dose ARB had significantly lower proteinuria, 1.0 +/- 0.8 gm/day compared to 1.7 +/- 1.0 g/day in the other groups (P = 0.0005). The loss in eGFR was 0.7 ml min(-1)year(-1) for high dose ARB compared to 3.2-3.5 ml min(-1)year(-1) for the other three groups (P = 0.0005). There were more patients on high dose ARB with improvement in eGFR compared to other three groups (P < 0.001). Comparing patients with the three ACE genotypes DD, ID and II, all three groups responded well to therapy with decrease in proteinuria (P < 0.002). Only those on low dose ACEI (10 mg/day) with the I allele had increased in ESRF (P = 0.037). Conclusion High dose ARB is more efficacious in reducing proteinuria and preserving renal function when compared with normal dose ARB and ACEI, and also obviates the genomic influence of ACE gene polymorphism on renal survival.

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