苯那普利联合厄贝沙坦对早期糖尿病肾病的干预研究

Benazepril combining irbesartan in treatment of early diabetic nephropathy

目的：研究苯那普利联合厄贝沙坦对早期糖尿病肾病（diabetic nephropathy，DN）患者肾功能、血浆脂联素（adiponectin，APN）和高敏C反应蛋白（high sensitivity-C response protein，hs-CRP）的影响。方法纳入2011年1月~2012年6月北京军区总医院内分泌科早期DN患者84例，所有患者均伴有1级高血压。随机分为常规组（n=42）及联合组（n=42），常规组予苯那普利（10～20）mg，联合组予苯那普利10mg联合厄贝沙坦（150～300）mg，疗程均为3个月。比较两组治疗前后患者内生肌酐清除率（creatinine clearance rate，Ccr）、24小时尿蛋白定量（24 h-UPE）及血浆APN和hs-CRP水平。结果两组治疗后Ccr及血浆APN水平均较治疗前明显升高，24 h-UPE和hs-CRP水平均较治疗前明显降低，差异有统计学意义（P＜0.05）。与常规组相比，联合组治疗后24 h-UPE[（124±23.1）mg/L vs.（167±38.1）mg/L]和hs-CRP[（12.8±1.1）mg/L vs.（4.1±1.3）mg/L]水平更低，而Ccr[（95±11.1）mL/min vs.（83±9.4）mL/min]和血浆APN[（6.1±1.6）mg/L vs.（4.9±1.5）mg/L]水平更高，组间比较差异有统计学意义（P＜0.05）。结论苯那普利联合厄贝沙坦治疗可更好地保护早期DN患者的肾功能，这可能与其能够较好地保护血管内皮功能和降低炎症反应有关。

Objective To study the influences of benazepril combining irbesartan on kidney function, adiponectin （APN） and high-sensitivity C-reactive protein （hs-CRP） in the patients with early diabetic nephropathy （DN）. Methods The early DN patients （n=84） accompanied by grade 1 hypertension were chosen from the Department of Endocrinology of the General Hospital of PLA Beijing Military Area Command from Jan. 2011 to Jun. 2012, and randomly divided into routine group and combining group （each n=42）. The routine group was given benazepril （10 mg-20 mg） and combining group was given benazepril （10 mg） and irbesartan （150 mg-300 mg） all for three months. The changes of endogenous creatinine clearance rate （Ccr） and 24 h-UPE, and levels of plasma APN and hs-CRP were compared in two group before and after treatment. Results The levels of Ccr and plasma APN increased significantly and levels of 24 h-UPE and hs-CRP decreased significantly in two groups after treatment （P〈0.05）. Compared with routine group, the levels of 24 h-UPE and hs-CRP were higher and levels of Ccr and plasma APN were lower in combining group （P〈0.05）. Conclusion Benazepril combining irbesartan can protect the kidney function in the patients with early DN, which may be related to the improvement of vascular endothelial function and antagonism of inflammatory reactions.