贝那普利和螺内酯联合治疗糖尿病肾病的临床研究

Clinical investigation of combined therapy with benazepril and spironolactone in diabetic nephropathy

目的:比较血管紧张素转换酶抑制剂(ACEIs)贝那普利和醛固酮受体阻滞剂螺内酯单独及联合治疗糖尿病肾病的疗效。方法:40例糖尿病肾病病人随机分为两组:联合治疗组20例,用贝那普利10 mg/d联合螺内酯20 mg/d治疗;贝那普利组20例,单用贝那普利10 mg/d。比较两组治疗前、治疗后1个月、治疗后3个月尿蛋白、血清肌酐、血钾变化。结果:治疗1个月后两组病人尿蛋白水平均明显下降,3个月后联合治疗组尿蛋白水平进一步下降,贝那普利组尿蛋白水平回升。两组病人的血清肌酐、血钾治疗前后均无明显变化。结论:糖尿病肾病病人长期应用ACEIs药物可出现尿蛋白定量水平反跳,该现象可能与醛固酮逃逸有关,联合服用醛固酮受体拮抗剂可改善该现象。

Objective： To compare the efficacies of the angiotensin converting enzyme inhibitor（ACEI） benacepril alone,and in combination with aldosterone receptor blocker spironolactone in treatment of diabetic nephropathy.Methods： Forty patients with diabetic nephropathy were randomly divided into 2 groups.In combination treatment group,20 cases were treated by benazepril 10 mg/d combined with spironolactone 20 mg/d.In benazepril group,20 cases were treated by benazepril 10 mg/d alone.The quantity of urine protein,the levels of serum creatinine and potassium in two groups were determined and compared before treatment,1 month and 3 months after treatment.Results： The quantity of urine protein was significantly decreased in two groups after 1 month treatment.Three months after treatment,the quantity of urine protein was further decreased in combination treatment group,while increased in benazepril group.There were no differences in levels of serum creatinine and potassium before and after treatment in two groups.Conclusion： The quantity of urine protein can rebound after a long-time treatment with ACEI only,which may be related to escape from aldosterone.The treatment of ACEI combined with aldosterone receptor blocker can improve the rebound of the quantity of urine protein.