坎地沙坦与非洛地平治疗2型糖尿病的疗效观察

The Clinical Study of the Combination of Candesartan and Felodipine in Treatment of Diabetic Nephropathy

目的:探讨坎地沙坦与氨氯地平联合治疗对早期糖尿病肾病的肾保护作用。方法:84例合并早期糖尿病肾病的2型糖尿病患者,随机分为3组,每组各28例。坎地沙坦组应用坎地沙坦4mg/d,氨氯地平组用氨氯地平5mg/d,联合用药组用坎地沙坦4mg/d和氨氯地平5mg/d。观察治疗前后尿白蛋白排出量(UAE)、平均动脉压(MAP)、糖化血红蛋白(HbAlc)、肾功能等指标的变化。结果:3组治疗后,UAE水平均显著下降(P<0.01),联合用药组下降幅度显著大于坎地沙坦组和氨氯地平组(P<0.05)。各组治疗后MAP显著降低(P<0.05),各组间治疗前后血压变化差异无统计学意义(P>0.05)。结论:坎地沙坦和氨氯地平联合应用较单独应用可显著降低早期糖尿病肾病患者的微量白蛋白尿,具有独立于降血压之外的肾脏保护作用。

Objective： To explore the protective effect of candesartan and amlodipine combination therapy on kidney in early diabetic nephropathy. Methods： 84 cases type 2 diabetic patients with early diabetic nephropathy were randomly divided into three groups, 28 cases in every group, and candesartan group with eandesartan 4mg / d; amtodipine group with amlodipine 5mg/d, the combination therapy group with Candesartan 4mg/ d and amlodipine 5mg / d. The urinary albumin excretion （UAE）, mean arterial pressure （MAP）, glyeosylated hemoglobin （HbAlc）, renal function and other indicators of change were observed before and after treatment, Results： UAE was significantly decreased in three therapy groups, （P 〈0.01）, and UAE in the combination therapy group was significantly lower than that in candesartan group and amlodipine group alone（P 〈0.05）. MAP was also significantly decreased in three therapy groups （P 〈0.05）, but there were no difference among three therapy groups （P〉0.05）. Conclusion： Candesartan and amlodipine combination therapy can reduce mieroalbuminuria in early diabetic nephropathy. It suggested that kidney protective effect of combination therapy should be beyond blood pressure reduction.