血管紧张素转换酶抑制剂联合血管紧张素Ⅱ受体拮抗剂治疗慢性肾脏疾病的利弊

doi:10.7504/nk2014080205

中国实用内科杂志

血管紧张素转换酶抑制剂联合血管紧张素Ⅱ受体拮抗剂治疗慢性肾脏疾病的利弊

王丽妍，刘文虎

作者单位：首都医科大学附属北京友谊医院肾内科首都医科大学肾病学系，北京 100050

出版日期:2014-09-01 发布日期:2014-09-05
作者简介: 刘文虎，主任医师、教授、博士生导师。首都医科大学附属北京友谊医院肾内科主任、首都医科大学肾病学系主任。兼任中华医学会肾脏病学分会常务委员、中国医师协会肾脏病医师分会常务委员等职；《中华肾脏病杂志》、《中国血液净化》、《中国全科医学》等期刊编委。承担北京市科委课题2项。发表论文50余篇，SCI收录期刊论文十余篇。 
基金资助:
北京市科学技术委员会科技计划重大项目课题(D131100004713001)

Combined therapy for chronic kidney disease with angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor antagonist：right and wrong aspects.

WANG Li-yan，LIU Wen-hu.

Department of Nephrology，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China

Online:2014-09-01 Published:2014-09-05

摘要/Abstract

摘要：

慢性肾脏病(CKD)患者通常存在肾素-血管紧张素-醛固酮系统(RAAS)的过度激活，是疾病进展的重要病理生理因素。针对RAAS的干预药物--血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体拮抗剂(ARB)，因具有降压和保护靶器官的作用，被广泛用于临床CKD患者的治疗中，也是多数指南推荐的一线药物。但如何合理应用该类药物目前尚未达成一致观点。文章就单独或联合使用ACEI和ARB治疗CKD的效果、药物剂量的选择，以及临床上如何合理应用此类药物等问题的最新观点做一综述。

关键词: 慢性肾脏疾病, 血管紧张素转换酶抑制剂, 血管紧张素Ⅱ受体拮抗剂

Abstract:

Abstract：Over activation of rennin angiotensin aldosterone system (RAAS) usually exists in patients with chronic kidney disease (CKD)，which is an important pathophysiological factor for the progression of CKD.As effective inhibitors of RAAS，angiotensin-converting enzyme inhibitor (ACEI) and angiotensin Ⅱ receptor antagonist (ARB) are widely used in clinical treatment of patients with CKD，due to their antihypertensive effects and target organ protection.They are also recommended as the first-line drugs by most guidelines.But how to use of the drugs rationally has not yet reached a consensus.In this review，we discuss the effects of ACEI and ARB used in combination or alone，selection of the dosage，and reasonable prescriptions of them in treatment of CKD.

Key words: chronic kidney disease, angiotensin-converting enzyme inhibitor, angiotensin Ⅱ receptor blocker

中图分类号:

R692

王丽妍，刘文虎. 血管紧张素转换酶抑制剂联合血管紧张素Ⅱ受体拮抗剂治疗慢性肾脏疾病的利弊[J]. 中国实用内科杂志, DOI: 10.7504/nk2014080205.

WANG Li-yan，LIU Wen-hu.. Combined therapy for chronic kidney disease with angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor antagonist：right and wrong aspects.[J]. Acta Metallurgica Sinica, DOI: 10.7504/nk2014080205.

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2014-04-12收稿 2014-06-06修回本文编辑：颜廷梅

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血管紧张素转换酶抑制剂联合血管紧张素Ⅱ受体拮抗剂治疗慢性肾脏疾病的利弊

Combined therapy for chronic kidney disease with angiotensin-converting enzyme inhibitor and angiotensin Ⅱ receptor antagonist：right and wrong aspects.

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