血管紧张素转换酶抑制剂和血管紧张素Ⅱ-1型受体拮抗剂联用治疗早期糖尿病肾病

Rationality of treating early diabetic nephropathy with combination of angiotensin-converting enzyme inhibition and angiotensin Ⅱtype 1 receptor antagonist

目的 探讨血管紧张素转换酶抑制剂 (ACEI)联用血管紧张素Ⅱ 1型受体 (AT1)拮抗剂治疗早期糖尿病肾病的合理性。方法 采用前瞻性试验研究 ,6 8例 2型糖尿病并发的早期糖尿病肾病患者 ,随机分为 3组 ,分别使用苯那普利 (n =2 2 )、伊贝沙坦 (n =2 5 )及两药联用 (n =2 1)治疗 18周 ,治疗前后分别检测平均动脉压 (MAP)、尿白蛋白排泄率 (UAER)、内生肌酐清除率 (CCr)、血清肌酐 (SCr)、血清尿素 (BUN)、空腹血糖 (FBG)、餐后 2h血糖(2hBG)、糖化血红蛋白 (HbA1c)、血脂分析、血清钾 ,进行同期组间比较及组内治疗前后比较。结果 ①各组治疗前后及同期各组间sCr、BUN、FBG、2hBG、HbA1c、血脂分析、血清钾变化均无统计学意义 ;②MAP治疗后总体下降 7.8%(P <0 .0 5 ) ,同期各组间无明显差别 ;③治疗后比较UAER ,苯那普利组下降了 33.9% (t =3.2 78,P =0 .0 0 4 ) ,伊贝沙坦组下降了 36 .2 % (t=4 .2 34,P<0 .0 0 1) ,两药联用组下降了 6 0 .9% (t=5 .75 4 ,P<0 .0 0 1) ,两单药组间下降幅度无明显差异 (P >0 .0 5 ) ,联用组较单药组下降幅度总体增加 2 6 .1%。结论 ACEI与AT1拮抗剂联合应用治疗早期糖尿病肾病是合理的。

Objective To detect the rationality of treating early diabetic nephropathy with the combination of angiotensin converting enzyme inhibition(ACEI) and angiotensin Ⅱ type 1 receptor(AT 1) antagonist.Methods According to the random and prospective study,a 18 weeks long therapy has been performed in 68 patients with type 2 diabetes and early diabetic nephropathy.22 cases selected by chance were cured with Benazpril only as group 1.Another 25 cases selected by chance were cured with Irbesartan only as group 2.The rest 21 cases were cured with the combination of Benazpril and Irbesartan as group 3.Before,during and after the therary,examinations were performed to every patient to determine parameters such as the mean arterial pressure(MAP),urinary albumin excretion rate(UAER),endogenous creatinine clearance(CCr),serum creatinine(SCr),blood urea nitrogen(BUN),fasting blood glucose(FBG),2 h blood glucose(2 hBG),hemoglobin A1c(HbA 1c),blood lipid and serum potassium.Results ①Before,during and after the therary,no obvious differences were found among each group on sCr,BUN,FBG,2 hBG,HbA 1c,blood lipid and serum potassium.② After the therapy,a 7.8% descent of MAP was found(P< 0.05 ),but there were no obvious differences between groups.③ The UAER descended 33.9% in group 1(t= 3.278 ,P= 0.004 ), 36.2% in group 2(t= 4.234 ,P< 0.001 ),and 60.9% in group 3(t= 5.754 ,P< 0.001 ).There was no obvious difference between group 1 and group 2(P> 0.05 ).The descent amplitude of group 3 was 26.1% higher than that of group 1 and group 2.Conclusion It is a reasonable and safe way to treat early diabetic nephropathy with the combination of ACEI and AT 1 antagonist.