ACEI與ARB合併療法之腎臟保護作用

高血壓與蛋白尿是腎臟疾病惡化的危險因子。研究已證實，使用angiotensin-converting enzyme inhibitors (ACEI)或angiotensin-receptor blockers (ARB)阻斷renin-angiotensin aldosterone system (RAAS)，能夠降低糖尿病與非糖尿病病患之蛋白尿並且延緩腎臟疾病惡化爲末期腎病(end-stage renal disease)，而此腎臟保護作用不完全來自於ACEI或ARB這兩類藥物的降壓作用。然而，在ACEI或ARB的單一藥物治療(monotherapy)下，有些腎臟病病患藥物能發揮良好的腎臟保護作用，但有些病患卻沒有相當的治療效果。因ACEI和ARB單一治療各有缺點，因此許多專家提出將ACEI與ARB合併治療可能達到較完全的RAAS阻斷作用，以增加腎臟保護作用。對於慢性腎疾病患者，目前的研究證實，ACEI與ARB合併治療能提供比單一藥物治療更佳的腎臟保護作用，並具有良好的耐受性。但目前的研究大多以替代指標（如蛋白尿）來評估合併療法的治療成效，未來的研究還需要設立較嚴格的腎功能指標來評估合併療法的腎臟保護作用。

關鍵字

合併療法；血管收縮素轉化酶抑制劑；血管收縮素受體阻斷劑；慢性腎疾病；腎臟保護作用

並列摘要

Hypertension and proteinuria are important risk factors for renal disease progression. There is clear evidence that blockade of the renin-angiotensin system with either angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) reduces proteinuria and slows down the progression of renal disease to end stage renal disease in diabetic and non-diabetic nephropathy. These beneficial effects are not entirely related to blood pressure control. Some patients exhibit benefit from suppressed renin-angiotensin system (RAS) from either ACEI or ARB therapy while others do not. Because of these shortcomings of monotherapy, many investigators are currently examining whether dual blockade of the RAAS by combination treatment with ACEI and ARB may offer more complete blockade of the RAAS. The available data suggest that combination treatment with ACEI and ARB has a greater renoprotective effect than monotherapy with either drug and is well tolerated in patients with chronic renal disease. Most clinical trials use surrogate endpoints (e.g., treatment. Clinical trials with rigorous endpoints are needed to establish the benefits of combination treatment in renoprotection.

並列關鍵字

Drug therapy, Combination ； Angiotensin-converting enzyme inhibitors, ACEI ； Angiotensin receptor blockers, ARB ； Chronic kidney disease, CKD ； Renoprotection

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ACEI與ARB合併療法之腎臟保護作用

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