血管紧张素Ⅱ受体拮抗剂与血管紧张素Ⅱ转化酶抑制剂联合应用治疗以肾病综合征表现的糖尿病肾病32例

Effect of ARB and ACEI on DN patients with nephrotic syndrome

目的 观察血管紧张素Ⅱ受体拮抗剂 (ARB)与血管紧张素Ⅱ转化酶抑制剂 (ACEI)联合应用和单用ACEI治疗以肾病综合征为临床表现的 2型糖尿病肾病 (DN)的疗效比较。方法 5 2例临床确诊的 2型糖尿病肾病分为两组 ,A组单用ACEI治疗 2 0例 ,B组ARB联合ACEI治疗 32例。结果 治疗 2个月后A组 2 4小时尿蛋白平均 3 0 2± 1 10g ,B组 2 4小时尿蛋白平均 2 6 6± 1 32g (P <0 0 1)。血浆白蛋白A组 2 4 6 0± 1 80g/L ,B组 2 6 80± 1 2 0g/L (P <0 0 5 ) ,6个月后 2 4小时尿蛋白A组 2 5 4± 0 89g/L ,B组 2 14± 1 0 3g/L (P <0 0 1) ,血浆白蛋白A组 2 8 80± 2 10g/L ,B组 31 10± 1 80g/L (P <0 0 1)。经过一年治疗 ,A组肌酐清除率平均下降速率为 3 5ml/min·y ,B组为 2 8ml/min·y。结论 ARB与ACEI联合应用对以肾病综合征为临床表现的 2型糖尿病肾病的治疗效果更优于单用ACEI组 ,并具有更好的肾脏保护作用。

Objective To observe the comparation of effects between combining usage of angiotensin receptor blockers(ARB)and angiotensin converting enzyme inhibitors(ACEI)and single usage of ACEI on type 2 diabetic nephropathy(DN)with nephrotic syndrome.Method 52 patients were divided into A or B groups,the patients in group A were treated with ACEI.The patients in group B were treated with ACEI and ARB.Results After treatment for tow months,24 hours urinary protein assay was 3.02±1.10 g in group A,and that was 2.66±1.32g in group B(P<0.01).Plasma albumin was 24.60±1.80 g/L in group A,and that was 26.8±1.20 g/L in group B(P<0.05).After treatment for six months,24 hours urinary protein assay was 2.54±0.89 g in group A,and that was 2.14±1.03 g in group B(P<0.01).Plasma albumin was 28.80±2.10 g/L in group A,and that was 31.10±1.80 g/L in group B(P<0.01).After treatment for one year,The rate of creatinine clearance decrease was 3.5 ml/min·year and 2.8 ml/min·year in group A and B patients respectively.Discussions Effects of ARB and ACEI on DN patients with nephrotic syndrome is better than ACEI alone,and that is better in the renal protective effects too.