氯沙坦联合培垛普利短期治疗糖尿病肾病的临床观察

Study on the clinical effect of losartan combined perindopril on treating early diabetic nephropathy

目的:探讨氯沙坦和培垛普利单独及联合短期治疗糖尿病肾病的临床疗效及其机制。方法:80例合并糖尿病早期肾病的2型糖尿病患者,随机分为4组:常规治疗组(n=20),只予常规降糖治疗;培垛普利组(n=20):常规治疗加培垛普利4 mg/d;氯沙坦组(n=20):常规治疗加氯沙坦50 mg/d;联用组(n=20):常规治疗加氯沙坦50mg/d与培垛普利4 mg/d;各组治疗8周,治疗前后分别检测尿白蛋白(UAL)、尿转化生长因子-β(TGF-β)、尿内皮素(ET)及肾功能、糖化血红蛋白(HbA1 c),另选取20例健康志愿者作正常对照。结果:①4组在治疗前UAL、尿TGF-β、尿ET之间无统计学意义,但上述指标较正常对照组明显上升(P<0.05);治疗8周后,培垛普利组、氯沙坦组和联用组的UAL,TGF-,βET水平均较治疗前明显下降(P<0.05),联用组较单用组下降更显著(P<0.05);常规治疗组UAL、尿TGF-β、尿ET水平治疗前后差异并无统计学意义。②各组治疗前后及同期各组间肾功能、HbA1 c变化均无统计学意义。结论:对于糖尿病早期肾病患者,氯沙坦和培垛普利联合治疗与单药相比更能显著降低UAL、尿TGFβ-、尿ET的排泄,可能更有利于延缓糖尿病早期肾病的发展。

Objective： To investigate the effect and mechanism of losartan combined perindopril on the patients with early diabetic nephropathy.Methods： All of 80 cases with early diabetic nephropathy were randomly divided into four groups：routine therapy（n=20）,perindopril（n=20）,losartan（n=20） and combination group（n=20）.The patients in above-mentioned four group had been treated with routine drugs,perindopril（4 mg/d）＋routing drugs,losartan（50 mg/d）＋routing drugs and perindopril（4 mg/d）＋losartan（50 mg/d）＋routine drugs respectively for eight weeks,and their UAL,urinary transforming growth factor-β（TGF-β）,urinary endothelin（ET）,renal function and serum lipid profile were measured.In addition,20 cases healthy volunteer served as a normal control group. Results： Before treatment,the levels of UAL,urinary TGF-β and urinary ET did not differ significantly among the four groups,but the indexes mentioned above were significantly higher than normal control group（P〈0.05）.Eight weeks later,the levels of urinary MA,urinary TGF-β and urinary ET in perindopril,losartan and combination group were significantly lower than that before treatment.（P〈0.05）,and combination treatment had more descendent indexes mentioned above than losartan or perindopril treatment alone. Conclusion： Combination of losartan with perindopril can significantly decrease the excretion of UAL,urinary TGF-β and urinary ET compared with the agents used separately in the early diabetic nephropathy and delay progress of the disease.