血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂对糖尿病肾病患者肾功能的保护作用

Clinical Study of the Protective Effect of ACEI and ARB on Patients with Diabetic Nephropathy

目的研究血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体拮抗剂(ARB)对2型糖尿病肾病患者肾功能的保护作用。方法选糖尿病合并有轻、中度肾功能损害的病人60例,在给予常规糖尿病治疗的同时随机分为3组,分别给予血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、血管紧张素转换酶抑制剂合并血管紧张素受体拮抗剂治疗,观察治疗前和治疗8周后血压、血肌酐及24 h尿蛋白的变化。结果3组治疗前24 h尿蛋白分别为(680±45)(、650±76)(、720±40)mg,治疗后分别为(450±50)(、420±65)(、300±35)mg。3组患者均显著降低了尿蛋白的排泄,各组治疗前后比较,差别有统计学意义(P<0.05),而联合治疗组减少尿蛋白排泄更为明显(P<0.01),且联合治疗组与其他两组相比,差别有统计学意义(P<0.05)。结论血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂联用能更好地起到肾脏保护的作用。

Objective To investigate the protective effect of angiotensin converting enzyme inhibitor （ACEI） and angiotensin receptor antagonist （ARB） on renal function of type 2 diabetic nephropathy patients. Methods 60 patients with type 2 diabetic nephropathy and mild or midrange damages of renal function were observed. The patients all accepted routine diabetic therapy and were randomly divided into three groups, ACEI group, ARB group and combination group with ACEI and ARB. The blood pressure, blood creatinine and urine protein of 24 hours were measured before therapy and 8 weeks after therapy. Results The excretive amounts of urine protein decreased in all groups. The excretive levels of urine protein in combination group significantly decreased than in ACEI group and ARB group （P〈0.05）. Conclusions Combination with ACEI and ARB in clinics might have more prospective effect on renal in diabetic nephropathy patients.