替米沙坦和氯沙坦减轻糖尿病肾病患者蛋白尿比较

Comparative study on telmisartan and losartan used for reducing proteinuria in patients with diabetic nephropathy

目的:比较替米沙坦和氯沙坦减轻糖尿病肾病患者蛋白尿的效果。方法:101例糖尿病肾病患者(血压水平>130/80mmHg或正在接受抗高血压药,且尿蛋白/肌酐比值≥700 mg·g-1随机分为替米沙坦组和氯沙坦组,用替米沙坦或氯沙坦治疗6个月,测量治疗前后的尿蛋白/肌酐比值和血压。比较6个月时2组间尿蛋白/肌酐比值。结果:2组的尿蛋白/肌酐比值较治疗前均降低,替米沙坦组蛋白尿减少29.5%,氯沙坦组减少22.1%,差异有显著性(P<0.05)。结论:替米沙坦减轻糖尿病肾病患者蛋白尿优于氯沙坦。

OBJECTIVE To compare the effectiveness of telmisartan and losartan in reducing proteinuria for diabetic nephropathy patients with hypertension. METHODS 101 diabetic nephropathy patients with hypertension （blood pressure level〉 130/80 mmHg or receiving antihypertensive medication（s） and urinary protein to cretatinine ratio≥700 mg.g 1 were randomly divided into telmisartan（a highly lipophlic agent with a long half-life）group or losartan（with low lipophlicity and short half-life） group and were treated with telmisartan or losartan for 6 months. Urinary protein to eretatiniue ralio and blood pressure were measured before and after treatment. The primary endpoint was the different in the urinary protein to cretatinine ratio between the groups at 6months. RESULLTS The urinary protein to eretatinine ratio fell in both groups at trial end. but it was significantly greater for the telmisartan compared to the losartan group, i. e. telmisartan group proteinuria decreased by 29. 5%, losartan decreased 22, 1 % （p〈0.05）. Mean systolic blood pressure reductions were not significantly different between groups. CONCLUSION Telmisartan is superior to losartan in reducing proteinuria in diabetic nephropathy patients with hypertension,de spite a similar reduction in blood Pressure.