JASN:肾素-血管紧张素系统(RAS)抑制对心肾结局的长期影响

2018-11-13 xing.T MedSci原创

由此可见,与ACEI单药治疗相比患者可能更能耐受ARB单药治疗。然而,来自该试验和类似试验的数据虽然没有定论,但没有得出白蛋白尿和糖尿病或其他心血管危险因素患者采用ACEI或ARBs作为双重或单药治疗会导致死亡率和肾脏结局差异的趋势。

血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体阻滞剂(ARBs)或联合治疗对白蛋白尿和存在心血管危险因素患者的疗效比较尚不清楚。

近日,肾脏病领域权威杂志Journal of the American Society of Nephrology上发表一篇研究文章。在这项多中心、随机、开放分组的试验中,研究人员评估了ACEI或ARB单药治疗或联合治疗对心血管事件的疗效,针对中度或重度白蛋白尿和糖尿病或其他心血管危险因素且血压<130/80mmHg的患者。研究终点包括心血管死亡、非致死性心肌梗死、非致死性卒中和心血管原因住院的主要复合事件以及全因死亡率的修订终点。其他终点包括ESRD、血清肌酐增倍、白蛋白尿、eGFR、血压和不良事件。

由于招募过程较慢,试验被修订,并终止了预期入组的2100名参与者的41%,相当于35%的效能来检测主要结局的风险降低25%。研究人员的分析纳入了1243名成人,中位随访时间为2.7年。各组间(ACEI与ARB,ACEI与联合用药,ARB与联合用药)的疗效结局以及严重不良事件发生率相似。ARB单药治疗的永久性停药率(6.3%)显著低于ACEI单药治疗(15.7%)或联合治疗(18.3%)。

由此可见,与ACEI单药治疗相比患者可能更能耐受ARB单药治疗。然而,来自该试验和类似试验的数据虽然没有定论,但没有得出白蛋白尿和糖尿病或其他心血管危险因素患者采用ACEI或ARBs作为双重或单药治疗会导致死亡率和肾脏结局差异的趋势。

原始出处:

Valeria Saglimbene,et al. The Long-Term Impact of Renin-Angiotensin System (RAS) Inhibition on Cardiorenal Outcomes (LIRICO): A Randomized, Controlled Trial.JASN,2018.https://jasn.asnjournals.org/content/early/2018/11/10/ASN.2018040443

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    2018-11-13 医者仁心5538

    学习了

    0

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    2018-11-13 天地飞扬

    了解一下,谢谢分享!

    0

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ANN ONCOL:RAS液体活检与转移性结直肠癌患者结局有关

液体活检是转移性结直肠癌患者肿瘤组织RAS检测的替代方案。但是对于接受一线抗EGFR治疗的患者,液体活检RAS检测的预后效果几乎未见报道。ANN ONCOL近期发表了一篇文章,研究了这一问题。

Nat Commun: BCL-XL直接调节RAS有利于癌细胞获得干细胞属性

肿瘤组织中,表达高水平抗凋亡蛋白(例如BCL-XL)的化学抗性细胞的积累被认为是在进展和/或初始治疗期间对敏感的低表达克隆进行反选择的结果。本研究中,研究人员发现,即使在没有促凋亡压力的情况下,BCL-XL表达选择性地有利于癌细胞群体。在转化的人乳腺上皮细胞中,BCL-XL有利于组合型活性RAS的下游信号的完全激活,以BH4依赖性的方式相互作用。对比蛋白质组学分析和功能测定表明,这对RAS诱导的干

Heart:经导管主动脉瓣置入术后肾素-血管紧张素系统阻断治疗效果如何?

术后RAS阻断治疗与左室质量指数的逆转有关,并且降低了全因死亡率。这些数据需要通过前瞻性随机对照结果试验来进一步予以证实。

Brit J Cancer:RAS野生型转移性结肠癌患者接受抗EGFR治疗响应的蛋白预测生物标志物

研究认为,活化的EGFR和PI3K是转移性结肠癌患者抗EGFR治疗响应的关键预测因素,对于RAS野生型转移性结肠癌患者的个体化治疗具有重要的临床指导作用

JAMA Oncology:RAS和BRAF突变Ⅲ期结肠癌患者肿瘤位置的预后价值

目前尚无研究针对原发肿瘤位置对不同BRAF,RAS和微卫星灶不稳定(MSI)状态的接受结肠癌切除并进行标准辅助化疗的患者预后的影响。JAMA Oncology近期发表了一篇文章,研究Ⅲ期结肠癌患者接受FOLFOX联合或不联合西妥昔单抗治疗后不同BRAF,RAS和MSI状态原发肿瘤位置的预后价值。