缬沙坦对2型糖尿病肾病患者的降压、肾功能保护作用及剂量选择分析

Effect of valsartan on blood pressure and renal function in patients with type 2 diabetic nephropathy

目的研究缬沙坦对2型糖尿病肾病患者的降压、肾功能保护作用及剂量选择。方法选择2013年3月-2015年3月温岭市第一人民医院收治的2型糖尿病肾病患者120例。按照随机数表法均分为2组。低剂量组和高剂量组分别应用80 mg和160 mg缬沙坦对患者进行治疗。观察治疗前后2组的血压、心脏结构指标和肾功能指标,并记录不良反应发生情况。结果治疗后,2组患者的收缩压、舒张压、收缩压标准差及舒张压标准差均显著低于治疗前（P〈0.05）,且高剂量组患者的夜间收缩压、舒张压、收缩压标准差及舒张压标准差均显著低于低剂量组（P〈0.05）;2组患者的左室舒张末期前后径、左心室室壁厚度及左心室射血分数均得到明显改善（P〈0.05）,且与低剂量组比较,高剂量组左室舒张末期前后径、左心室室壁厚度均较低,左心室射血分数较高,差异均具有统计学意义（P〈0.05）;2组患者24h尿蛋白定量、血肌酐及血尿素氮水平均明显降低,且高剂量组水平显著低于低剂量组（P〈0.05）。2组不良反应发生率比较差异无统计学意义。结论 160 mg缬沙坦对2型糖尿病肾病患者降压效果良好,且肾功能保护作用较强,安全性高。

Objective To study the protective effect of valsartan on blood pressure and renal function in patients with type 2 diabetic nephropathy.Methods 120 cases of type 2 diabetic nephropathy patients from March 2013 to March 2015 in our hospital were selected,according to the random number table method were randomly divided into two groups. low dose group were treated with 80 mg valsartan,high dose group were treated with 160 mg valsartan. Before and after treatment,the blood pressure,cardiac index and renal function were observed in two groups,and the adverse reactions were recorded. Results After treatment,the systolic blood pressure,diastolic blood pressure,systolic blood pressure standard deviation and standard deviation of diastolic blood pressure in the two groups were significantly lower than those before treatment（ P〈0. 05）,and nocturnal systolic,diastolic and systolic blood pressure and the standard deviation of diastolic blood pressure were significantly lower than those of low dose group（ P〈0. 05）; Left ventricular end diastolic diameter,left ventricular wall thickness and left ventricular ejection fraction of the two groups were significantly improved（ P〈0. 05）,compared with the low dose group,left ventricular end diastolic diameter and left ventricular wall thickness were lower,left ventricular ejection fraction was higher,the difference was statistically significant（ P〈0. 05）; The levels of 24 h urinary protein,serum creatinine and blood urea nitrogen were significantly lower（ P〈0. 05）,and the high dose group was significantly lower than the low dose group（ P〈0. 05）; the adverse reactions of the two groups of patients had no significant difference. Conclusion 160 mg valsartan in patients with type 2 diabetic nephropathy patients with good antihypertensive effect,and the protective effect of renal function is strong,high safety.