苯那普利与缬沙坦联用对早期糖尿病肾病的影响

The effect of combination therapy with valsartan and benazepril for early diabetic nephropathy

目的观察苯那普利和缬沙坦联合应用对早期糖尿病肾病的保护作用。方法2型糖尿病患者90例，随机分成3组：苯那普利组，缬沙坦组和联合治疗组。观察治疗6个月前后各组患者的血压，24 h尿蛋白排泄率（UAER），血清肌酐（Scr）和尿素氮（BUN），血糖、血脂、糖化血红蛋白（HbA1 c）和血清胰岛素变化。结果单独用苯那普利或缬沙坦，和联合应用两药均可明显降低血压，减少UAER。尽管降低血压各组间对比差异无统计学意义（P〉0.05），但联合应用组降低UAER更明显（P均〈0.05）。各组治疗后血清胰岛素均有明显降低（P均〈0.05），而血糖、血脂、糖化血红蛋白无显著性变化。结论苯那普利联合缬沙坦治疗早期糖尿病肾病，较单独应用这两种药物能更有效地降低血压，减少UAER，阻止或延缓早期糖尿病肾病的发展，也可能通过降低血清胰岛素改善代谢而达到对早期糖尿病肾病的保护作用。

Objective To observe the effeets of eombination therapy of valsartan and benazapril in the treatment of early diabetie nephropathy. Methods Ninety patients with diabetie nephropathy were random divided equally into three groups, valsartan treatment group, benazepril treatment group and eombination treatment group. After medieation for 6 months, the patients underwent examinations for ehanges in the mean arterial blood pressure （MABP）, serum ereatinine （Ser）, blood urea nitrogen （BUN） and 24 hours urine protein exeretion （ UAER）, blood glueose, serum lipid, glyeosylated hemoglobin AIe （ HbA1c ） and serum insulin （SI）. Results Valsartan or benazepril alone or in eombination significantly deereased MABP and UAER （ P 〈 0. 05 ）. In spite of absent signifieant differenees among three groups, eombination therapy of the two drugs predueed the most obvious reduetion of UAER. Valsartan or benazepril did not intluenee blood glueose, serum lipid and HbAle, but signifieantly deereased serum insulin. Conclusion Combined use of valsartan and benazepril may deerease MABP and UAER more than the use of valsartan or benazepril alone.