缬沙坦对早期糖尿病肾病的治疗作用探讨

Treatment of early diabetic nephropathy with Valsartan

目的 探讨血管紧张素ⅡⅠ型受体拮抗剂 (AT1Ra)缬沙坦 (Valsartan)对伴微量白蛋白尿的早期糖尿病肾病的治疗作用。方法 6 4例Ⅱ型糖尿病患者 (2 4h尿蛋白排泄率 2 0～ 2 0 0 μg/min)在原抗糖尿病的基础上 ,随机分为四组 ,一组为正常对照 (16例 ) ,其余三组分别给予缬沙坦 80mg/d(16例 )、缬沙坦 16 0mg/d(16例 ) ;依那普利2 0mg/d(16例 )。观察 12周后平均动脉压 (MAP)、2 4hUAER、HbA1c及Ccr等指标的变化。结果 12周后 ,MAP、2 4hUAER均有明显变化 (P <0 0 5 ) ,但尿微量白蛋白排泄率的下降与血压下降无显著相关性 (r =0 36 5 )。结论 缬沙坦可以降低早期糖尿病肾病的蛋白尿 ,对早期糖尿病肾病具有肾脏保护作用 。

Objective: To evaluate and observe the effect of angiotensinⅡⅠ type receptor antagonists(AT1Ra) Valsartan on the early diabetic nephropathy with microalbuminuria. Methods: 64 cases of type 2 diabetes mellitus(DM ) [24h urine albumine excretion rate (UAER)20～200 μg/min] were divided into four groups at random; one was normal control group(n=16), the others were given Valsartan 80 mg qd(n=16) Valsartan 160 mg qd (n=16),Enaplapril 20 mg qd (n=16), and placebo(n=16) respectively without changing the previous management of DM. After 12 weeks of the treatment the changes of mean arterial pressure(MAP),UAER,HbA1c,Ccr were observed. Results: No change of the above indices was observed in the control group. In the other three groups the MAP and 24 h UAER, changed significantly(P<0 05). The decrease in micro albumin excretion rate was not related to the change of blood pressure。Conclusion: AT1Ra Valsartan is effective in reducing microalbumin excretion in the early diabetic nephropathy and is well tolerated in the patients.