奥美沙坦酯治疗肥胖相关性肾病的疗效评价

目的观察奥美沙坦酯对肥胖相关性肾病患者胰岛素抵抗指数（HOMA-insulin resist-ance index，HOMA-IR）、微炎症状态、24h尿蛋白定量（24 hours urinary albuminuria，24hUAlb）、血压的影响。方法将32例肥胖相关性肾病患者随机分为观察组和治疗组，每组16例。观察组行低脂饮食、适当运动、控制体质量，治疗组在观察组的基础上加用奥美沙坦酯片20rag／次，每日1次，疗程12周。比较2组患者治疗前、后空腹胰岛素（fastinginsulin，FINS）、空腹血糖（fastingbloodsugar，FBG）、超敏C反应蛋白（high-sensitivityC-reactiveprotein，hs—CRP）、24hUAlb、血肌酐（serumcreati-nine，SCr）、总胆固醇（totalcholesterol，TC）、三酰甘油（triglyceride，TG）水平，计算HOMA-IR、内生肌酐清除率（creatinineclearance，Ccr）及体质量指数（bodymassindex，BMI），治疗前、后及观察期间监测收缩压（systolicbloodpressure，SBP）、舒张压（diastolicbloodpressure，DBP）。另取健康对照组16名检测上述指标作为正常对照。结果治疗前观察组及治疗组SBP、DBP、体质量指数、FBG、FINS、H（）M～IR、24hUAlb、SCr、Ccr、hs—CRP、TC、TG比较无统计学差异（P〉0．05），对照组除SCr外，其他指标显著低于观察组及治疗组（P（O．01）。观察组治疗后体质量指数、HOMA-IR、FINS、TC、TG明显下降（P〈（）．01），SBP、DBP、FBG、24hUAlb、Ccr较治疗前下降（PdO．05），hs-CRP、SCr无统计学差异（P〉0．05）；治疗组治疗后体质量指数、HOMA-IR、FINS、SBP、DBP、FBG、24hUAlh、Ccr、hs-CRP、TC、TG明显下降（P〈0．01），SCr无统计学差异（P〉0．05）。治疗后组间比较，HO-MA_IR、FINS、SBP、DBP、FBG、24hUAlb、Ccr、hs-CRP明显下降（P〈0．01），TC、TG比较无统计学差异（P〉0．05）。治疗组无明显不良反应发生。结论奥美沙坦酯可显著改善肥胖相关性肾病患者胰岛素抵抗及微炎症状态，显著降低患者高血压、肾小球高灌注及24hUAlb水平，延缓慢性肾脏病的进展，安全性好。

Therapeutic effect of olmesartan in the treatment of obesity-related glomerular diseaseHUZhao-

Objective To observe the effect of olmesartan on insulin resistance index, micro-in- flammatory state,24-h urinary protein（24-hUAlb）and blood pressure of patients with obesity-related glomerular disease （ORG）. Methods Thirty-two ORG patients were randomly divided into observa- tion group （n = 16） and treatment group （n = 16）. The patients in observation group were given low fat diet,appropriate exercise and weight control, and those in treatment group were given olmesartan（20 rag/day） for 12 weeks additionally. The FINS, FBG, hs-CRP, 24-h UAlb, SCr, TC, TG, SBP and DBP were measured. HOMA-IR and Ccr were calculated and compared. Sixteen healthy persons served as control group. Results There were no significant differences in SBP, DBP, BMI, FBG, FINS, HOMA- IR,24-h UAlb, SCr,Ccr, hs-CRP,TC and TG between the observation group and treatment group be- fore treatment （P~〉0. 05）. Except SCr,the rest indexes in the control group were lower than those in the observation group and treatment group （P~0. 01 ）. After 12-week treatment, the BMI, HOMA-IR,FINS, TC, TG, SBP,DBP,FBG,24-h UAlb and Ccr showed obviously significant difference from those before treatment in the observation group （P%0. 05 or P%0. 01）, while hs-CRP and SCr showed no obvious changes （P ~0. 05）. In the treatment group, the BMI, HOMA-IR, FINS, SBP,DBP, FBG,24-h UAlb, Ccr, hs-CRP, TC and TG were decreased significantly （P〈50. 01） as compared with those before treatment,and the SCr showed no obvious changes （P~0. 05）. As compared with the observation group,the HOMA-IR,FINS,SBP,DBP,FBG,24-h UAlb,Ccr and hs-CRP after treatment in the treat- ment group were significantly reduced （P~0. 01 for all）,but there was no significant difference in TC and TG （P~0. 05）. There was no adverse effect in the treatment group. Conclusions Olmesartan can significantly improve the insulin resistance and micro-inflammatory state on ORG patients, significantly decrease high blood pressure,high perfusion of glomerulus and 24-h UAlb, and retard the progress of chronic kidney disease.