羟苯磺酸钙和培哚普利联合治疗早期糖尿病肾病

Combination Treatment of Calcium Dobesilate and Perindopril for Diabetic Nephropathy in Early Stage

目的 观察羟苯磺酸钙和培哚普利联合应用对早期糖尿病肾病（DN）患者的微量白蛋白尿的疗效和对肾功能的保护作用。方法 糖尿病患者55例，其尿白蛋白排泄率（AER）均在20-200μg／min之间，所有患者经控制饮食、口服降糖药物和／或采用胰岛素治疗，使血糖控制在可接受水平（空腹血糖〈7．0mmol／L，餐后2h血糖〈10．0mmol／L），随机分成两组。A组为对照组27例，在控制血糖基础上加用培普利4mg／d；B组为治疗组28例，在控制血糖基础上加用培哚普利4mg／d和羟苯磺酸钙3000mg／d（分3次口服）。两组患者在治疗前及治疗后3,6、12个月复查空腹血糖（FBG）、餐后2h血糖（PBG）、糖化血红蛋白Alc（HbAlc）和AER等。结果 A组在治疗后3、6、12个月时，AER分别为（23．8±5．6）μg／min、（23．7±6．O）μg／min、（22．9±5．8）μg／min，与治疗前的（45．8±7．6）μg／min相比有明显降低（P〈0．05）。B组治疗后3、6、12个月时，AER分别为（21．8±7．1）μg／min、（19．9±5．9）μg／min、（19．1±6．1）μ／min，与治疗前的（46．1±7．1）μ／min相比有明显降低（P〈0．05）；B组治疗后6、12个月时，AER均低于同期A组水平（P〈0．05）。结论 羟苯磺酸钙和培哚普利联合应用，对伴微量白蛋白尿的早期DN患者减少尿蛋白和保护肾功能有良好的效果，其疗效优于培哚普利单独应用。

Objective To observe the curative effect of protein urine after combination treatment of calcium dobesilate and perindopril for DNand its protective action for renal function. Methods 55 cases of diabetes patient with AER between 20 -200 μg/min who underwent treatment of control diet and blood glucose were divided into two groups. Group A of 27 cases as control group was treated with 4 mg/d perindopril on base of routine therapy. Group B of 28 cases as therapy group was treated 3 000 mg/d （t.i.d.） on the base of group A. The FBG, PBG, ALe, and AER before treatment and3, 6, 12 months after treatment were detected. Results The AERingroup A at 3, 6, 12 months after treatment were （23.8±5.6） μg/min, （23.7±6.0） μg/min, （22.9±5.8） μg/min compared with that （45.8±7.6） μg/min before treatment （ P 〈0.05）. The AER in group B at3, 6, 12 months after treatment were （21.8±7.1） μg/min, （19.9±5.9） μg/min, （19.1±6.1） μg/min compared with that （46.1±7.1） μg/min before treatment （ P〈0.05）. The results of AER in group B were lower than those in group A with P 〈 0.05. Conclusion The combination use of two drugs might decrease the protein urine and protect renal function especially better than that in single use of perindopril.