替米沙坦与螺内酯配伍对早期糖尿病肾病76例微量白蛋白尿及脑钠肽的影响

Effect of telmisartan and spironolactone on microalbuminuria and brain natriuretic peptide in early diabetic nephropathy

目的:探讨替米沙坦与螺内酯配伍对早期糖尿病肾病患者微量白蛋白尿及脑钠肽的影响,以观察血管紧张素Ⅱ受体拮抗剂与醛固酮受体拮抗剂联用对早期糖尿病肾病的治疗作用。方法:将76例早期糖尿病肾病患者随机分为替米沙坦与螺内酯配伍治疗(治疗组)和单用替米沙坦治疗(对照组)两组,每组38例。治疗前及治疗3月后分别检测两组尿微量白蛋白排泄率(UAER)、脑钠肽(BNP)、血肌酐(Scr)、血糖、糖化血红蛋白(HbA1c)、血钾等的变化并进行分析。结果:治疗前后,两组患者血糖、糖化血红蛋白、血钾、肌酐等指标变化均无显著性差异(P>0.05),但治疗后两组UAER、BNP水平均较治疗前显著降低(P<0.05);而治疗组UAER、BNP水平下降较对照组更为明显(P<0.05)。结论:替米沙坦与螺内酯配伍治疗早期糖尿病肾病,尿微量白蛋白及脑钠肽水平下降更为明显,且无严重不良反应。

Objective：To study the effect of telmisartan and spironolactone on microalbuminuria and plasma level of brain natriuretic peptide（BNP）in early diabetic nephropathy,so as to investigate the effect of combined therapy of angiotensin Ⅱ recepter antagonist and mineralocorticoid receptor（MR） antagonist in early diabetic nephropathy.Methods：76patients were involved in this study.The 2 groups of patients were administered of combined therapy of telmisartan and spironolactone and telmisartan alone.The levels of urinary albumin excretion rate（UAER）,plasma level of BNP,serum creatinine,blood sugar,glycated hemoglobin,blood potassium,were measured at the beginning and the end of research.Results：There were no significant changes on level of serum creatinine,blood sugar,glycated hemoglobin,blood potassium before and after treatment,but the level of urinary albumin excretion rate,plasma level of BNP after 12 weeks treatment was sig-nificantly reduced（P 0.05）;The better curative effect was observed in group which accepted both telmisartan and spironolactone.Conclusion：Combined therapy of telmisartan and spironolactone in early diabetic nephropathy is superior to use telmisartan alone and no apparent side effect is observed.