马来酸依那普利和硝苯地平缓释片治疗2型糖尿病肾病合并蛋白尿和高血压的临床分析

Clinical analysis of enalapril maleate and nifedipine sustained-release tablets in the treatment of type 2 diabetic nephropathy with proteinuria and hypertension

目的比较和分析血管紧张素转换酶(ACE)抑制剂(依那普利)和长效钙离子拮抗剂(硝苯地平缓释片)对2型糖尿病肾病(Diabetic nephropathy,DN)尿蛋白、高血压、及肾功能的治疗效果。方法将74例DN患者(男51例,女23例,平均年龄62±7岁)随机分为三组:马来酸依那普利组(27例)、硝苯地平缓释片组(24例)及两药联合治疗组(23例)。三组在严格控制血糖和饮食的基础上,分别服用依那普利5 mg、硝苯地平缓释片5 mg,清晨口服,每日1次,如果治疗2周后血压仍未降至正常(>140/90 mmHg),则马来酸依那普利、硝苯地平缓释片分别增加至10 mg,共用12周。结果两药单独治疗均可明显降低DN高血压(P<0.01),减少24小时尿白蛋白排出(P<0.05)。两药联合治疗降低血压和降低尿蛋白的幅度明显优于单独治疗(P<0.01)。结论马来酸依那普利和硝苯地平缓释片治疗DN所引起的高血压均有较好的降压作用,且能减少24小时尿蛋白的排泄,两药联合治疗疗效具有协同作用。

Objectice To Compare and analyze the treatment effect of angiotensin-converting enzyme （ACE） inhibitor （Enalapril maleate）, and long-acting calcium antagonist （nifedipine sustained-release tablets） on the type 2 diabetic nephropathy proteinuria,hypertension, and renal function. Methods 74 cases DN patients （male 51 cases, female 23 cases, the average age of 62±7 years old） were randomly divided into three groups： Enatapril maleate group （27 cases）, Nifedipine Sustained-release tablets group （24 cases）and the two drugs in the treatment group （23 cases）. Three groups in the strict control of blood sugar and diet, enalapril maleate and nifedipine sustained-release tablets each were taking 5 mg,oral morning,once a day, after two weeks if the treatment had not yet returned to normal blood pressure （〉140/90 mmHg）, enalapril maleate and nifedipine sustained-release tablets each increased to 10 mg,sharing 12 weeks. Results The treatment of the two drugs alone could significantly reduce the DN hypertension （P 〈 0.01） and the 24-hour urinary protein excretion （P 〈 0.05）. Two drugs in the treatment of lower blood pressure and reduced the rate of urinary protein was better than treatment alone （P 〈 0.01）. Conclusions Enalapril maleate and nifedipine sustained-release are better antihypertensive effect on hypertension caused by type 2 DN and can reduce the 24-hour urinary protein excretion. Two drugs in the treatment are synergies.