氯沙坦联合ACEI治疗糖尿病肾病高血压的临床应用

Clinical Application of Combination ACEI Losartan in Treating Diabetic Nephropathy

目的 评价血管紧张素Ⅰ转换酶抑制剂（ACEI）和血管紧张素Ⅱ受体－1拮抗剂（ATla)联合治疗糖尿病肾病（DN）伴高血压的临床价值。方法 观察两组糖尿病肾病伴高血压患者，比较联合应用氯沙坦和ACEI（治疗组）与单独使用大剂量ACEI（对照组）在降低血压和尿白蛋白排泄（UAE）、影响糖代谢和肾功能以及不良反应等方面的差异。结果 治疗8周后两组尿蛋白、UAE、血压均明显下降，治疗组下降幅度大于对照，副作用出现率低（P<0.05)，控制血糖所需的胰岛素剂量、血沉酐等变化和组间差异不显著（P>0.05)。结论 ATla和ACEI是治疗DNA的有效药物，联合应用更有利于保护肾脏，可能是临床治疗方案的一种选择。

Objective To study the benefit of combination angiotensin converting enzyme inhibitor (ACEI) and angiotensin type 1 receptor antagonist (ATl1) therapy in diabetic nephropathy. Methods Two groups of hypertensive diabetes nephropathy patients were treated with combination ACEI+losartan (treated group) and high dose ACEI(control group) therapy separately. Difference of reducing blood pressure and albuminuria and influencing metabolism and side effects was evaluated between two groups. Results After 8 weeks treatment, blood pressure and urinary albumin eduction (UAE) rate in both two groups were decreased significantly. In treated group, reducing is more significant and side effects observed were fewer than control group. Dosage of insulin to control hyperglucose and serum creatinine did not changed significantly. Conclusion ACEI and ATla are too benefit to hypertensive diabetic nephropathy patients, and combination therapy is better in clinical treatment.