ACEI与ARB联用治疗糖尿病肾病的疗效观察

Observation on efficacy of ACEI combined with ARB in treating diabetic nephropathy

目的观察肾素血管紧张素转化酶抑制剂（ACEI）药物与血管紧张素Ⅱ受体阻滞剂（ARB）药物联用治疗糖尿病肾病（diabeticnephropathy，DN）的疗效。方法将60名确诊为Ⅳ期糖尿病肾病患者随机分为3组：ACEI组、ARB组及ACEI＋ARB联合治疗组。比较观察治疗8周后3组患者血压、血肌酐、24h尿蛋白定量、钾离子浓度的变化。结果经过治疗，联合治疗组在治疗后24h尿蛋白定量下降35．7％，效果优于ACEI组11．1％及ARB组11．5％（P〈0．05）；血肌酐水平联合治疗组下降0．92％，效果优于ACEI组0．56％及ARB组7．6％（P〈0．05）。而联合治疗组患者血钾浓度（4．6±0．2）与ACEI组（4．6±0．4）及ARB（4．6±0．4）组相比，差异无统计学意义（P〉0．05）。结论ACEI与ARB联合治疗糖尿病肾病可提高降压效果并明显降低蛋白尿，优于单用ACEI和ARB，且用药安全，不良反应少。

Objective To observe efficacy of combination of angiotensin-converting enzyme inhibitor （ACEI） and angiotensin receptor blocker （ARB） for treating diabetic nephropathy. Methods A total of 60 patients with diabetic nephropathy were randomly divided into ACEI group, ARB group, and combination group. Patients in ACEI group were given benazepril, patients in ARB group were given valsartan, and patients in combination group were given benazepril and valsartan. Eight weeks after their respective treatments, a 24-hour proteinuria excretion, blood pressure, serum creatinine, electrolyte （K＋） were observed and compared with those indexes prior to the treatment. Results The 24-hour proteinuria excretion and blood pressure of combination group reflected significantly lower than the rest two groups （P 〈0.05）. Yet, no significant differences were found in levels of serum creatinine, electrolyte （K＋） among the three groups before and after the treatment （P 〉0.05）. Conclusion The combination of ACEI with ARB definitely reduces 24-hour proteinuria excretion and blood pressure on diabetes nephropathy patients than ACEI or ARB alone, with safety and less side-effect.