氯沙坦改善早期糖尿病肾病患者肾功能的疗效观察

The efficacy of losartan to improve renal function in patients with early diabetic nephropathy

目的观察氯沙坦治疗早期糖尿病肾病患者肾脏血流动力学及肾功能的变化。方法58例糖尿病肾病患者服用氯沙坦50mg／（次·d）治疗8周，治疗前后测尿肌酐、尿清蛋白排泄率（UAER）、糖化血红蛋白（HbA1c）、血肌酐（Scr）、血尿素氮（BUN）、空腹血糖（FBG）和血脂（TG）。采用彩色多普勒及频谱多普勒超声检查，测量收缩期峰值流速（Vs）、舒张末期最低流速（Vd）、平均流速（Vm）、搏动指数（PI）、阻力指数（RI）。结果58例患者经过治疗，各项指标除BUN外，UAER、HbA1c、Scr、FBG、TG均有显著降低，与治疗前比较差异有统计学意义（P〈0．05）。治疗后双肾动脉舒张末期最低流速（Vd），平均流速（Vm）显著增高。搏动指数（PI），阻力指数（RI）均显著降低，与治疗前比较差异有统计学意义（P〈0．05）。结论氯沙坦治疗早期糖尿病肾病可以减少尿蛋白的排出，改善临床症状，彩色多普勒超声检测糖尿病肾病肾血管血流参数的变化对糖尿病肾病疗效评价具有一定价值。

Objective To observe the effect of losartan for treatment of early diabetic nephropathy and renal function in patients with renal hemodynamic changes. Methods 58 patients with diabetic nephropathy in patients taking losartan 50 mg/ （time · day） for 8 weeks. Before and after treatment, urinary creatinine, urinary albumin excretion rate （UAER）, glycosylated hemoglobin （HbAlc）, serum creatinine （Scr）, blood urea nitrogen （BUN）, fasting blood glucose （FBG） and lipid （TG） were measured. Color Doppler and spectral Doppler ultrasound were per- formed. Peak systolic velocity （Vs）, end diastolic minimum velocity （Vd}, mean velocity （Vm）, pulsatility index （PI）, resistance index （RI） were measured. Results The indicators exceptfor BUN, UAER, HbAlc, Scr, FBG, TG were significantly reduced compared with before treatment in 58 patients. The difference was statistically significant （P〈0.05 ）. After treatment, the lowest renal artery end-diastolic velocity （Vd）, mean velocity （Vm） was significantly higher, and pulsatility index （PI）, resistance index （RI） were significantly lower. The difference was statistically significant （P〈0.05 ） . Conclusion Losartan treatment for early diabetic kidney disease can reduce urinary protein excretion, and improve the clinical symptoms. Color Doppler ultrasound to deteetthe renal blood flow param- eters on the evaluation of diabetic nephropathy has some values.