血管張力素轉化酶抑制劑與腎臟疾病

近年來末期腎病變的病人有逐年增多的趨勢，醫療花費亦逐年增加，血管張力素轉化酶抑制劑可抑制血管張力素－Ⅱ的生成，可改善腎臟血流動力（降低腎絲球微血管壓力、維持正常腎絲球廓清率），和經由非血流動力因素來減緩腎絲球功能及結構之破壞（如改善腎絲基底膜之物質）。近年來的研究顯示對糖尿病或非糖尿病的腎病變患者給予血管張力素轉化酶抑制劑治療可降低尿蛋白清除率、減緩發生腎絲球硬化速率、遲延腎功能惡化、避免或延緩到達末期腎病變、減少需要透析治療或腎臟移植，以減少醫療花費。

關鍵字

腎素－血管張力素系統；血管張力素轉化酶抑制劑；胰舒血管酶；前列腺素；腎臟疾病

並列摘要

In recent years, angiotensin converting enzyme inhibitors (ACEI) are found to possess a very important therapeutic effect on diabetic as well as non-diabetic renal diseases. ACEI acts by inhibiting the conversion of angiotensin-I to angiotensin-II and may enhance the tissue level of bradykinin. ACEI not only lower the blood pressure but also exert profound and generally welcome effects on intrarenal hemodynarmics and on glomerular as well as tubular function, thus providing a beneficial protection to the affected kidneys. The intrarenal hemodynamics are improved by reducing the intraglomerular capillary pressure and normalization of glomerular filtration. Through non-hemodynamic mediated effect ACEI directly improve the glomerular basement membrane permeability, cytostatic effect, antioxidative effect, and inhibition of metalloprotinases, finally reducing the proteinuria and delaying the declination of renal function. ACEI also offer certain metabolic benefits by increasing insulin sensitivity and improving glucose tolerance, which is attributable to generation of bradykinin. Compared with other antihypertensive agents, ACEI are more efficient in preventing the progressive deterioration of renal function. It is well documented in many studies that ACEI can prevent or slow down the progression of renal dysfunction and at the same time reduce the urinary albumin excretion, delay the time for dialysis or renal transplantion and may probably help in minimizing the medical expenses.

並列關鍵字

Renin-angiotensin system ； angiotensin converting enzyme inhibitors ； bradykinin ； prostaglandin ； renal disease

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血管張力素轉化酶抑制劑與腎臟疾病

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