替米沙坦对糖尿病肾病患者半胱氨酸及颈动脉内膜厚度的影响

Effect of telmisartan on levels of serum homocysteine and carotid intima media thickness in patients with early diabetic nephropathy

目的:分析替米沙坦对糖尿病肾病(DN)患者半胱氨酸(Hcy)以及颈动脉内膜中层厚度(IMT)的影响。方法:选取120例2型糖尿病肾病患者为研究对象,随机分为观察组和对照组,每组各60例。对照组采用常规降糖治疗,观察组在此基础上联合替米沙坦治疗,6个月后比较治疗前后血浆半胱氨酸(Hcy)、尿清蛋白排泄率(UAER)、血脂及颈动脉IMT的变化。结果:112例患者保持随访,经规范降糖治疗6个月,血糖、血压控制稳定。两组患者血脂指标如TG、TC、LDL-C较治疗前均有不同程度的降低,但观察组TC、LDL-C较对照组下降更为明显(P<0.05);对照组治疗前后24h尿蛋白定量、Hcy、颈动脉IMT无明显变化,观察组24h尿蛋白定量、Hcy、颈动脉IMT较治疗前显著降低,且明显低于对照组,差异具有统计学意义(P<0.05)。结论:替米沙坦治疗糖尿病肾病可改善脂质代谢过程,降低Hcy和尿蛋白排泄,延缓肾功能损害以及动脉粥样硬化过程。

Objective. To investigate the effects of telmisartan on the blood biochemical indexes, the levels of serum homocysteine （Hey） and carotid intima media thickness （IMT） in patients with early diabetic nephropathy（DN）. Methods. A total of 120 patients with early type 2 DN and normal blood pres- sure were randomly divided into observation group and control group according to random digital table with each group 60 cases. The two groups were both given routine treatment. The observation group was given telmisartan 80 mg/d in addition and the course of treatment was 6 months. The 24 h urine albumin excretion rate （UAER）, blood lipid, serum Hcy and carotid IMT before treatment and 6 months after treatment were compared between the two groups. Results. All patients＂ blood pressure and blood glocuse were under control during 6 months regular treatment. TG, TC, LDL-C in both two groups were all im- proved after treatment, but the improvement in observation group were better than the control group. 24 h UAER, Hcy, carotid IMT in control group showed no obvious changes after treatment, but 24 h UAER, Hcy, carotid IMT in observation group had obvious improvement after treatment, and the chan- ges were better than control group. Conclusions. Telmisartan can improve insulin resistance of patients with early DN,significantly reduce the levels of UAER,the serum levels of Hey and carotid IMT. It can protect kidney independent of its antihypertensive effect and can delay the development of atherosclerosis.