沙库巴曲缬沙坦与厄贝沙坦联合氨氯地平治疗糖尿病肾病合并高血压患者的效果比较

Comparison of effects of Sacubitril/Valsartan and Irbesartan combined with Amlodipine in treatment of diabetic nephropathy complicated with hypertension

目的:比较沙库巴曲缬沙坦与厄贝沙坦联合氨氯地平治疗糖尿病肾病(DN)合并高血压患者的效果。方法:选取2021年1月至2023年1月该院收治的90例DN合并高血压患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各45例。对照组给予厄贝沙坦联合氨氯地平治疗,观察组给予沙库巴曲缬沙坦联合氨氯地平治疗。比较两组临床疗效,治疗前后血压指标[收缩压(SBP)、舒张压(DBP)]水平、血糖指标[空腹血糖(FBG)、糖化血红蛋白(HbAlc)、餐后2 h血糖(2hPG)]水平和肾功能指标[肌酐(Scr)、血尿素氮(BUN)、24 h尿蛋白(24hUP)、胱抑素C(CysC)]水平,以及不良反应发生率。结果:两组治疗总有效率比较,差异无统计学意义(P>0.05);治疗后,两组SBP、DBP水平均低于治疗前,但组间比较,差异无统计学意义(P>0.05);两组FPG、2hPG及HbAlc水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组Scr、BUN、24hUP及CysC水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:沙库巴曲缬沙坦与厄贝沙坦联合氨氯地平DN合并高血压患者的降压效果相当,但沙库巴曲缬沙坦联合氨氯地平治疗降低血糖指标水平和肾功能指标水平的效果优于厄贝沙坦联合氨氯地平治疗。

Objective:To compare effects of Sacubitril/Valsartan and Irbesartan combined with Amlodipine in treatment of diabetic nephropathy(DN)patients with hypertension.Methods:A prospective study was conducted on 90 patients with DN complicated with hypertension admitted to the hospital from January 2021 to January 2023.According to the random number table method,they were divided into control group and observation group,45 cases in each group.The control group was treated with Irbesartan combined with Amlodipine,while the observation group was treated with Sacubitril/Valsartan combined with Amlodipine.The clinical efficacy,the blood pressure indexes[systolic blood pressure(SBP),diastolic blood pressure(DBP)]levels,the blood glucose indexes[fasting blood glucose(FBG),glycosylated hemoglobin(HbAlc),postprandial 2h blood glucose(2hPG)]levels,the renal function indexes[creatinine(Scr),blood urea nitrogen(BUN),24h urine protein(24hUP),cystatin C(CysC)]levels before and after the treatment,and the incidence of adverse reactions were compared between the two groups.Results:There was no significant difference in the total effective rate between the two groups(P>0.05).After the treatment,the levels of SBP and DBP in the two groups were lower than those before the treatment,but there were no significant differences between the two groups(P>0.05).The levels of FPG,2hPG and HbAlc in the two groups were lower than those before the treatment,those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The levels of Scr,BUN,24hUP and CysC in the two groups were lower than those before the treatment,those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:The antihypertensive effect of Sacubitril/Valsartan and Irbesartan combined with Amlodipine in the treatment of the DN patients with hypertension is similar,but Sacubitril/Valsartan combined with Amlodipine can reduce the levels of blood glucose indexes and renal function indexes,and it is superior to Irbesartan combined with Amlodipine.