血管紧张素转化酶抑制剂和血管紧张素Ⅱ受体拮抗剂联合治疗对2型糖尿病患者尿白蛋白排泄的影响

Combined therapy of angiotensin-converting enzyme inhibitor and angiotensin-Ⅱ receptor antagonist in type 2 diabetic patients with overt albuminuria.

目的 探讨血管紧张素转化酶抑制剂和血管紧张素Ⅱ受体拮抗剂联合治疗在降低 2型糖尿病患者尿白蛋白排泄率方面是否较单一治疗更为有效。方法 将 68例伴有临床白蛋白尿 ( >300mg/24h)的 2型糖尿病患者随机分为A、B两组,A组给予血管紧张素转化酶抑制剂 (福辛普利 10mg/d),B组给予血管紧张素Ⅱ受体拮抗剂(络沙坦 50mg/d),共 8周。随后将A组随机分为A1和A2两个亚组,B组随机分为B1和B2两个亚组。A1亚组和B1亚组仍以单药治疗,A2亚组加用络沙坦 50mg/d,B2亚组加用福辛普利 10mg/d,共 8周。分别于治疗前、治疗后 8周和 16周测定空腹血糖、糖化血红蛋白、血压、血钾、血肌肝、血尿素氮、内生肌酐清除率和尿白蛋白排泄率。结果 福辛普利和络沙坦单药治疗以及两者联合治疗对空腹血糖、糖化血红蛋白、血钾、血肌酐、血尿素氮和内生肌酐清除率均无明显影响。福辛普利和络沙坦单药治疗均可使血压和尿白蛋白排泄率降低,两者效果相当。福辛普利和络沙坦联合治疗可使血压和尿白蛋白排泄率进一步降低。结论 用血管紧张素转化酶抑制剂和血管紧张素Ⅱ受体拮抗剂双重阻断肾素 血管紧张素系统在降低 2型糖尿病患者尿白蛋白排泄率方面较单一治疗更有效。

Objective To appraise the ameliorating effect of combined therapy of angiotensin-converting enzyme inhibitor and angiotensin-Ⅱ receptor antagonist in patients with type 2 diabetes melitus complicated by overt albuminuria,and compare the effectiveness with either alone.Methods A total of 68 type 2 diabetic patients with overt albuminuria(urinary albumin excretion rate>300 mg/24 hours) were randomly assigned to receive angiotensin-converting enzyme inhibitor (fosilopril 10 mg once a day;group A) or angiotensin-Ⅱ receptor antagonist (losartan 50 mg once a day;group B).After 8 weeks,patients in group A and B were either randomly divided into two subgroups A1 and A2,and B1 and B2.Patients in the subgroup A1 and B1 still received monotherapy. Whereas the subgroup A2 was added losartan 50 mg once daily,and patients in subgroup B2 added fosilopril 10 mg once daily for an additional 8 weeks.The fasting plasma glucose,HbA 1c,systolic blood pressure,diastolic blood pressure,blood potassium,urea nitrogen,creatinine,endogenous creatinine clearance rate and urinary albumin excretion rate were measured at baseline by the end of 8 and 16 weeks.Results The fasting plasma glucose,HbA 1c,blood potassium,urea nitrogen,creatinine and endogenous creatinine clearance rate remained unchanged throughout the course of the therapy.Blood pressure and urinary albumin excretion rate decreased equally in both fosilopril and losartan groups.A more profound reduction was achieved after the combined therapy.Conclusions Dual blockade of the renin-angiotensin system with both angiotensin-converting enzyme inhibitor and angiotensin-Ⅱ receptor blocker in type 2 diabetic patients with overt albuminuria is superior to either drug alone.