醛固酮受体拮抗剂治疗糖尿病肾病的临床研究

Clinical study on aldosterone receptor antagonist for the treatment of diabetic nephropathy

目的:探讨应用醛固酮受体拮抗剂能否改善糖尿病肾病患者的炎症病变、减少糖尿病肾病患者的蛋白尿排泄。方法:采用前瞻性随机对照方法,对糖尿病肾病(Ⅲ、Ⅳ期)患者60例,按照1:1分为治疗组(螺内酯)和对照组(安慰剂),予ACEI类或AT1RA类的药物治疗基础上加用螺内酯片(20mg/d)或安慰剂,共治疗12周。检测治疗前后24h尿微量白蛋白、尿单核细胞趋化蛋白-1(MCP-1)、肾功能等情况。结果:治疗后两组的肌酐清除率均较治疗前升高,但治疗组治疗前后比较差异有非常显著性(59.4±13.4,61.2±13.5,P=0.000)。两组治疗前后的24h尿微量白蛋白及尿MCP-1比较差异均有显著性(P<0.05),但治疗组治疗前后24h尿微量白蛋白及尿MCP-1比较差异有非常显著性(1450.13±1369.84,779.33±656.57,P=0.001;39.69±9.71,32.79±6.74,P=0.000)。治疗前后二者定量呈明显正相关。结论:醛固酮受体拮抗剂能改善糖尿病肾病患者的炎症病变,明显减少蛋白尿排泄,延缓了糖尿病肾病的进展。

Objective In order to test whether aldosterone receptor antagonist can improve the inflammatory lesions and reduce proteinuria excretion in patients with diabetic nephropathy. Methods Sixty patients with diabetic nephropathy were divided into treatment group （spironolactone） and control group （placebo） according to 1：1. The prospective randomized confrontation method was used. The treatment group was treated by ACEI plus spironolactone （20 rag/d） and control group by AT1RA plus placebo for 12 weeks. 24 h microdose albumin in urine, MCP-1 in urine, renal function etc. were tested before and after treatment. Results After treatment, the creatinine clearance rate in the both groups was higher than that before treatment,in which the difference in treatment group was statistically significant （59.4 _＋ 13.4, 61.2 ＋ 13.5,P = 0.000）. The difference in both groups before and after treatment was significant （P 〈0.05） in the 24h urinary albumin excretion rate and urinary MCP-1 excretion. The difference of treatment group before and after treatment was significant in the 24 h urinary albumin excretion rate and urinary MCP- 1 excretion （ 1 450.13 ± 1 369.84,779.33 ± 656.57, P = 0.001 ; 39.69 ± 9.71,32.79 ± 6.74, P = 0.000）. Before and after treatment,quantitation between urinary MCP-1 and urinary albumin was significantly correlated. Conclusion The aldosterone receptor antagonist can improve inflammatory lesions in patients with diabetic nephropathy, reduce significantly urinary albumin excretion, and delay the progress of diabetic nephropathy.