大剂量缬沙坦和舒洛地特对临床期糖尿病肾病尿白蛋白排泄率的影响

目的 探讨大剂量缬沙坦联合舒洛地特对2型糖尿病临床期糖尿病肾病（DN）的尿白蛋白排泄率（UAER）的影响.方法 120例2型糖尿病临床期DN随机分四组,在糖尿病一般治疗的基础上,分别使用普通剂量80 mg缬沙坦（A组）、大剂量320 mg缬沙坦（B组）、大剂量320 mg缬沙坦联合舒洛地特（C组）及160 mg缬沙坦联合舒洛地特（D组）,疗程8周.比较各组的尿白蛋白排泄率及血浆PAI-1、血压及血清尿素氮、肌酐等生化指标的变化.结果 治疗4周后,C组UAER与治疗前比较,差异有统计学意义（t=2.46,P＜0.05）.治疗8周后,B、C、D组UARE与治疗前比较,明显下降,差异均有统计学意义（t分别=4.12、7.63、4.94,P均＜0.05）;治疗后B、C、D三组UAER与A组比较,差异均有统计学意义（t分别=3.85、5.03、4.13,P均＜0.05）,治疗后C组UAER与B、D两组比较,差异均有统计学意义（t分别=2.93、3.17,P均＜0.05）.且B、C、D三组PAI-1治疗后与治疗前比较,明显下降,差异均有统计学意义（t分别=2.81、3.13、2.61,P均＜0.05）.结论 大剂量320 mg缬沙坦联合舒洛地特更能安全有效地降低临床期DN患者的UAER,具有良好的肾脏保护作用.

Effect of large-dose valsartan combined with sulodexide on urinary albumin excretion rate in patients with clinical-stage diabetic nephropathy

Objective To investigate the therapeutic effect of large-dose valsartan combined with sulodexide on urinary albumin excretion rate in patients with clinical-stage diabetic nephropathy. Methods A total of 120 cases of type 2 diabetes with clinical-stage diabetic nephropathy were randomly divided into four groups：group A （valsartan 80 mg qd, for 8 weeks）; group B （valsartan 80 mg qd, po for 1 week, valsartau 320 mg qd, po for 7 weeks）,group C （valsartan 80 mg qd, po for 1 week, valsartan 320 mg qd, po for 7 week and sulodexid 600 LSU qd, im for 4 weeks, sulodexid 250 LSU bid,po for 4 weeks） and group D （valsartan 80 mg qd, po for 1 week, valsartan 160 mg qd, po for 7 week and sulodexid 600 LSU qd, im for 4 weeks, sulodexid 250 LSU bid, po for 4 weeks）. Four groups were treated with the same basic diet control and routine treatment, and the levels of urinary albumin excretion rate （UAER）,serum urea nitrogen, serum creatinine ,blood pressure and plasminogen activator inhibitor-1 were determined. Results After four-week treatment, the level of UAER was decreased significantly compared with that before treatment in C group （t=2.46, P〈0.05 ）. After eight-week treatment, the levels of UAER in group B,C and D were decreased significantly compared with that before treatment （t=4.12, 7.63, 4.94, P〈0.05）; the levels of UAER in group B,C and D were decreased significantly than that in group A （t=3.85, 5.03, 4.13, P〈0.05）; the level of UAER in C group was decreased significantly than that in group B and D （t=2.93,3.17,P〈 0.05）;the levels of PAI- 1 in group B, C and D had significantly differences before and after treatment（t=2.81,3.13,2.61, P〈0.05）. Conclusions Large-dose （320rag） valsartan combined with sulodexide can decrease the level of UAER in pa- tients with clinical-stage diabetic nephropathy safely and effectively and can protect renal function well.