螺内酯与缬沙坦联合应用对早期糖尿病肾病患者肾功能的影响

Effect of spironolactone combined with valsartan on renal function in patients with early diabetic nephropathy

目的探讨螺内酯与缬沙坦联合应用对早期糖尿病肾病患者肾功能的影响。方法选取2014年5月~2015年6月湖州市南浔区人民医院内分泌科收治的早期糖尿病肾病患者158例,随机分为2组,各79例。对照组予缬沙坦治疗,实验组在对照组的基础上加以螺内酯治疗。治疗后,比较2组患者的临床疗效、肾功能、钾离子及血液流变学变化。结果治疗后,与对照组相比,实验组收缩压及舒张压水平较低（P〈0.05）,尿白蛋白排泄率（urinary albumin excretion rates,UAER）水平较低（P〈0.05）,白蛋白（albumin,Alb）、血清肌酐（serum creatinine,Scr）、血尿素氮（blood urea nitrogen,BUN）、肌酐清除率（creatinine clearance,Ccr）及K＋水平比较差异无统计学意义,全血比黏度、血浆比黏度及全血比还原黏度水平较低（P〈0.05）。结论螺内酯与缬沙坦联合应用能够有效改善早期糖尿病肾病患者的临床疗效,改善患者的肾功能,恢复离子紊乱,降低血液的粘稠度。

Objective To investigate the effect of spironolactone combined with valsartan on renal function in patients with early diabetic nephropathy. Methods 158 early diabetic nephropathy patients from May 2014 to June 2015 in department of endocrinology of Nanxun People＇s Hospital of Huzhou were selected and divided into control group（ 79 cases） and experimental group（ 79 cases）. The control group were treated by valsartan and the experimental group were treated with spironolactone on the basis of control group. The changes of renal function,potassium ion and blood rheology were observed and compared after treatment. Results Compared with control group post-treatment,the systolic pressure and diastolic pressure levels were lower,plasma urinary albumin excretion rates（ UAER） level was lower（ P〈0. 05）,albumin（ Alb）,serum creatinine（ Scr）,blood urea nitrogen（ BUN）,creatinine clearance（ Ccr） and K＋levels had no significant differences,whole blood specific viscosity,plasma specific viscosity and whole blood specific reduced viscosity were lower（ P〈0. 05） in experimental group. Conclusion Spironolactone combined with valsartan could effectively improve clinical efficacy of patients with early diabetic nephropathy,improve the renal function of patients,recover ion disorder and reduce blood viscosity.