血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂联合治疗糖尿病肾病的临床研究

The observation of therapeutic efficacy of combination of ACEI and ARB on diabetic nephropathy

目的比较血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)单独及联合治疗糖尿病肾病(DN)的疗效。方法183例DN患者,随机分为三组,分别予贝那普利、洛沙坦或两药联合治疗12周。比较治疗前后血压、尿蛋白及血钾和血Cr等的变化。结果上述两药均能有效降低DN的血压和尿蛋白且作用相似;联合治疗的降尿蛋白作用更明显(P<0.05),但二者的降压效果相似(P>0.05)。治疗前后的血钾、血Cr和Ccr无明显变化(P>0.05)。结论对于DN患者,ACEI和ARB联合治疗与单药相比具有更强的降尿蛋白作用,且这种作用是通过独立于血压的机制实现的。

Objective To investigate the efficacy of monotherapy or combination of ACEI and ARB in treating diabetic nephropathy（DN）. Methods 183 patients with DN were randomly allocated into three treatment groups： benazepril, losartan or the combination of these two drugs for 12 weeks. The changes of blood pressure, proteinuria, serum potassium and creatinine, ereatinine clearance（Ccr）were observed before and after treatment. Results Both of benazepril and losartan reduced blood pressure and proteinuria efficiently. And their effects were similar. In contrast, the reduction in proteinuria was greater in the combination therapy than in treatments of either drug alone（P 〈0.05）, but their reductions in blood pressure were achieved to the same level（P〉0.05）. There were not significant differences in serum levels of potassium, creatinine and Ccr before and after treatment（P〉0.05）. Conclusion A combination of ACEI and ARB in patients with DN produces a better anti-proteinuric effect than either of the monotherapies. This protection is not dependent on changes in blood pressure.