丹红注射液联合厄贝沙坦治疗早期糖尿病肾病的疗效观察

目的观察丹红注射液和厄贝沙坦治疗早期糖尿病肾病(DN)的效果。方法将血压正常的糖尿病早期肾病患者40例分为厄贝沙坦治疗组和丹红注射液联合厄贝沙坦治疗组,疗程均为6个月。结果厄贝沙坦组和丹红联合厄贝沙坦组均能显著改善DN患者的尿白蛋白排泄率及尿β2-微球蛋白,(均为P<0.05),而丹红联合厄贝沙坦组疗效优于单用厄贝沙坦组(P<0.05)。结论丹红注射液和厄贝沙坦治疗DN有减少蛋白尿,改善肾功能的功效。     

厄贝沙坦治疗早期糖尿病肾病患者的临床研究

目的 探讨厄贝沙坦在治疗早期糖尿病肾病患者的疗效.方法 将44例早期糖尿病肾病的患者随机分为两组,厄贝沙坦组22例,予口服厄贝沙坦300mg/d,对照组22例,予口服氨氯地平5mg/d,治疗前及后8周、16周分别检测血压、尿微量白蛋白排泄率(UAER)、β2-微球蛋白、血肌酐及血尿素氮指标的变化情况.结果 厄贝沙坦组治疗后UAER和β2-微球蛋白有明显下降,且与对照组治疗后该两项指标比较有显著性差异.但UAER和尿β2微球蛋白下降幅度与血压变化无显著性相关.结论 厄贝沙坦在治疗早期糖尿病肾病中可明显降低蛋白尿,对肾功能具有一定的保护作用.     

糖尿病肾病蛋白尿患者的临床治疗体会

目的 探究糖尿病肾病蛋白尿患者应采用的治疗方法和治疗效果。方法 77例糖尿病肾病蛋白尿患者,随机分为两组,实验组39例患者选择丹参注射液和厄贝沙坦综合治疗,对照组38例患者仅采用厄贝沙坦治疗,对比两组患者的治疗效果。结果 实验组患者治疗总有效率为94.9%,对照组患者治疗总有效率为81.6%。两组患者的治疗效果比较差异有统计学意义(P<0.05)。结论 糖尿病肾病蛋白尿患者采用丹参注射液和厄贝沙坦综合治疗,效果显著,不良反应较少,值得推荐。     

辛伐他汀联合厄贝沙坦治疗早期糖尿病肾病80例观察

目的糖尿病肾病（DN）是糖尿病最常见的微血管并发症,是终末期肾病的主要病因,积极控制糖尿病肾病尿微量白蛋白的进一步增加,可延缓糖尿病肾病的进展。本文通过观察我院80例早期糖尿病肾病治疗前后尿微量白蛋白（UAER）、TC、TG、LDL-C来探讨治疗早期糖尿病肾病的方法。方法将80例早期糖尿病肾病（DN）患者随机分成3组,对照组为积极控制血糖、血压;厄贝沙坦组为在此基础上加口服厄贝沙坦150mg.d^-1;厄贝沙坦＋辛伐他汀组在厄贝沙坦组基础上加辛伐他汀20mg.d^-1。结果两治疗组治疗后较对照组尿白蛋白排泄率均明显减少（P〈0.05）,厄贝沙坦＋辛伐他汀组减少程度较厄贝沙坦组更明显（P〈0.05）;厄贝沙坦＋辛伐他汀组治疗后血脂水平明显下降（P〈0.05）。结论表明早期DN患者应用辛伐他汀联合厄贝沙坦治疗能有效延缓肾损害进展。     

前列地尔联合厄贝沙坦治疗高血压糖尿病致肾病早期微量白蛋白尿的临床分析

目的探讨前列地尔联合厄贝沙坦治疗高血压、糖尿病或二者并存致肾病早期微量白蛋白尿临床价值。方法对46例尿微量白蛋白(U-MAIb)30~200mg/L的高血压、糖尿病或二者并存患者,在常规治疗的同时,分别给予厄贝沙坦150mg口服1次/日;厄贝沙坦150mg口服1次/日,联合前列地尔10μg入壶,生理盐水100mL静冲,1次/日;疗程3周。结果血压较治疗前显著下降(P<0.05);尿微量白蛋白(U-MAIb)较治疗前显著下降(P<0.05);尿素、肌酐较前无明显变化(P>0.05)。结论前列地尔联合厄贝沙坦治疗高血压、糖尿病或两者并存致肾病早期微量白蛋白尿疗效确切,在延缓高血压肾病及糖尿病肾病进展上有至关重要作用。     

大剂量厄贝沙坦对早期糖尿病肾病微量白蛋白尿的影响

<正>糖尿病肾病是危害仅次于肾小球肾炎的一种严重肾脏疾病,对患者的身体健康有着严重威胁[1]。同时,其也是糖尿病患者最严重的合并症。该病会导致严重的代谢紊乱,对临床治疗带来困难。糖尿病肾病晚期可进展为终末期肾病,严重损害患者肾脏健康,因此在发病早期即给予及时有效的治疗措施对保护肾脏功能有着重要意义。厄贝沙坦是一种血管紧张素受体抑制剂,可通过松弛肾     

黄葵胶囊联合厄贝沙坦片治疗糖尿病肾病的疗效观察

目的观察黄葵胶囊联合厄贝沙坦片治疗糖尿病肾病的临床疗效。方法糖尿病肾病而肾功能未受损患者102例,分为A组63例,B组39例。2组患者均给予糖尿病教育和糖尿病饮食控制,常规口服降糖、降压药物,A组在口服厄贝沙坦基础上,口服黄葵胶囊,B组单独服用厄贝沙坦。观察2组治疗前及治疗后12周24h尿蛋白、尿β2微球蛋白水平。结果治疗12周后2组尿蛋白及尿β2微球蛋白较治疗前明显降低,差异均有统计学意义(P<0.05和P<0.01);且治疗12周后A组尿β2微球蛋白值低于B组,差异有统计学意义(P<0.05)。结论黄葵联合厄贝沙坦片治疗糖尿病肾病有明确临床疗效。     

贝那普利与厄贝沙坦对糖尿病高血压的降压及蛋白尿的疗效比较

目的为探讨贝那普利与厄贝沙坦对糖尿病高血压患者的降压疗效及对糖尿病肾病患者蛋白尿的疗效比较。方法将符合糖尿病、高血压及糖尿病肾病蛋白尿的患者60例随机分层分组。分为两组,每组30例。A组应用贝那普利片,每晨10mg,1次顿服,疗程8周。B组应用厄贝沙坦片,每晨150mg,1次顿服,疗程8周。结论贝那普利与厄贝沙坦均有不同的降压疗效,而厄贝沙坦组不论在偶测血压及24h平均血压中的SBP或是DBP及降压总疗效均显著优于贝那普利;而对24h尿蛋白的排泄量方面治疗后两组均有明显减少。而贝那普利组显著优于厄贝沙坦组,说明贝那普利对肾脏保护作用更强于厄贝沙坦。     

厄贝沙坦联合黄芪注射液治疗早期糖尿病肾病疗效观察

目的 观察厄贝沙坦联合黄芪注射液治疗糖尿病早期肾病(DN)的临床疗效。方法 90例早期DN患者随即分为观察组(厄贝沙坦联合黄芪注射液),ARB组(厄贝沙坦)及对照组各30例;观察6周,比较治疗前后患者尿微量白蛋白排泄率(UAER)、尿β2-微球蛋白(β2-MG)、平均动脉压(MAP)、血清肌酐(Scr)及糖化血红蛋白(...     

渴络欣联合厄贝沙坦治疗早期糖尿病肾病蛋白尿的临床研究

目的 观察渴络欣联合厄贝沙坦治疗早期（Ⅲ期）糖尿病肾病患者蛋白尿的疗效.方法 将102例Ⅲ期糖尿病肾病患者随机分为试验组54例和对照组48例.试验组予以渴络欣联合厄贝沙坦治疗,对照组单用厄贝沙坦治疗.2组治疗8周后检测并比较24h尿蛋白定量及血肌酐、血清白蛋白水平.结果 2组治疗后24h尿蛋白定量低于治疗前,血清白蛋白水平高于治疗前,且试验组24小时尿蛋白定量低于对照组,差异具有统计学意义（P＜0.05）.2组均未出现明显不良反应.结论 渴络欣联合厄贝沙坦治疗早期（Ⅲ期）糖尿病肾病安全、有效,在减少尿蛋白方面效果优于单用厄贝沙坦.     

A French cost-consequence analysis of the renoprotective benefits of irbesartan in patients with type 2 diabetes and hypertension

ABSTRACT

Objectives: We performed a cost-consequence analysis in a French setting of the renoprotective benefit of irbesartan in hypertensive type 2 diabetes patients over a 25-year period.

Research design and methods: A previously published Markov model simulated progression from microalbuminuria to overt nephropathy, doubling of serum creatinine, end-stage renal disease and death. Three treatment strategies with analogous blood pressure control were compared: (A) control – conventionally medicated antihypertensive therapy (excluding angiotensin converting enzyme inhibitors, other angiotensin-2-receptor antagonists and dihydropyridine calcium channel blockers) initiated at microalbuminuria; (B) early irbesartan – (300?mg daily added to control, initiated with microalbuminuria) and (C) late irbesartan – (300?mg daily, initiated with overt nephropathy). Probabilities came from the Irbesartan in Reduction of Microalbuminuria-2 study, Irbesartan in Diabetic Nephropathy Trial and other sources. Clinical and economic outcomes were projected over 25 years. Annual discount rates were 3%.

Results: Compared to control, early use of irbesartan added (mean ± standard deviation) 1.51 ± 0.08 undiscounted life years (discounted: 0.94 ± 0.05 years), while late irbesartan added 0.07 ± 0.01 (0.04 ± 0.01) years/patient. Early irbesartan added 1.03 ± 0.06 discounted quality-adjusted life years (QALYs), while late irbesartan added 0.06 ± 0.01 QALYs. Early and late irbesartan treatments were projected to save €22?314 ± 1273 and €6619 ± 820/patient, respectively versus control. Sensitivity analysis showed that even over short time horizons both irbesartan treatments were superior to the control group.

Conclusions: In France, early irbesartan treatment improved quality and length of life and reduced costs in hypertensive patients with type 2 diabetes and microalbuminuria. Late irbesartan therapy is beneficial, but earlier irbesartan leads to better outcomes.     

Irbesartan: a review of its use in hypertension and in the management of diabetic nephropathy

Irbesartan (Avapro, Aprovel) is a potent and selective angiotensin II subtype 1 receptor antagonist indicated for use in patients with hypertension, including those with type 2 diabetes mellitus and nephropathy. Once-daily administration of irbesartan provided 24-hour control of blood pressure (BP). In patients with mild-to-moderate hypertension irbesartan was as effective as enalapril, atenolol and amlodipine, and more effective than valsartan in terms of absolute reduction in BP and response rates. Irbesartan produced a greater reduction in diastolic BP at trough than once-daily losartan, but had a smaller effect than olmesartan; the reduction in systolic BP achieved with irbesartan was similar or greater than that with losartan and similar to that seen with olmesartan. The combination of irbesartan with hydrochlorothiazide produced additive effects on BP reduction. Irbesartan also induced regression of left ventricular mass in patients with hypertension and left ventricular hypertrophy. In two large studies (IRbesartan MicroAlbuminuria type 2 diabetes mellitus in hypertensive patients [IRMA 2] and the Irbesartan Diabetic Nephropathy Trial [IDNT]) irbesartan exerted a renoprotective effect in hypertensive patients with type 2 diabetes at both the early and later stages of diabetic nephropathy. The renoprotective effect was at least partly independent of the BP-lowering effect. In the IRMA 2 trial, the proportion of patients progressing to overt nephropathy was significantly lower for recipients of irbesartan 300mg once daily than placebo. In patients with overt nephropathy in the IDNT, irbesartan 300mg once daily provided significantly greater renoprotection than amlodipine 10mg once daily or placebo. The relative risk of doubling of serum creatinine was significantly lower with irbesartan than amlodipine or placebo. Irbesartan is well tolerated in hypertensive patients, including those with type 2 diabetes and incipient or overt nephropathy. The overall incidence of adverse events with irbesartan was similar to that with placebo. Irbesartan was associated with a lower incidence of cough than enalapril and was not associated with ankle oedema or with any clinically significant drug interactions. In conclusion, irbesartan is a well tolerated and effective antihypertensive agent. It also slows the progression of renal disease in hypertensive patients with type 2 diabetes at both the early and later stages of diabetic nephropathy. Thus, irbesartan is a valuable agent in the management of patients with these indications.     

Cost effectiveness of ACE inhibitor treatment for patients with type 1 diabetes mellitus

OBJECTIVE: Current guidelines recommend treating patients with type 1 diabetes mellitus with ACE inhibitors after the onset of microalbuminuria. Recent clinical trials have shown ACE inhibitors can affect the development of nephropathy when initiated prior to the onset of microalbuminuria. Our objective is to examine the cost effectiveness of treating adults aged over 20 years with an ACE inhibitor (captopril) immediately following diagnosis of type 1 diabetes versus treating them after the onset of microalbuminuria. DESIGN: Using a semi-Markov model, we calculated four main outcome measures: lifetime direct medical costs (discounted), QALYs, cumulative incidence of end-stage renal disease (ESRD), and number of days of ESRD over a lifetime. Medical costs are in 1999 US dollars. SETTING: All analyses were from the viewpoint of a single US payer responsible for all direct medical costs, including screening for microalbuminuria, ACE inhibitor treatment (captopril), management of major diabetic complications, and routine annual medical costs not specific to diabetes. METHODS: We applied the model to a hypothetical cohort of 10,000 persons newly diagnosed with type 1 diabetes. Distribution of sex and race/ethnicity within the cohort is representative of the general US population. RESULTS: We estimated that the incremental cost of early use of captopril for the average adult with type 1 diabetes is USD 27,143 per QALY. This level varies considerably with age and glycaemic level. When the age at onset of diabetes is 20 years and glycosylated haemoglobin (HbA(1c)) level is 9%, the cost-effectiveness ratio is USD 13,814 per QALY. When the age at onset is 25 years and HbA(1c) level is 7%, the cost-effectiveness ratio is USD 39,530 per QALY. CONCLUSION: This model, with its underlying assumptions and data, suggests that early treatment with captopril provides modest benefit at reasonable cost effectiveness, from the US single-payer perspective, in the prevention of ESRD compared with delaying treatment until diagnosis of microalbuminuria. Early treatment with other ACE inhibitors will provide similar cost effectiveness if they have equivalent efficacy, compliance and price per dose. Treatment may be considered among patients at age 20 years with new onset of type 1 diabetes. This conclusion is sensitive to the extent that ACE inhibitors delay onset of microalbuminuria. Other factors such as the patient's age and glycaemic level must be considered when deciding to initiate early treatment.     

不同剂量厄贝沙坦对早期糖尿病肾病微量白蛋白尿的影响

目的：对不同剂量厄贝沙坦对早期糖尿病肾病微量白蛋白尿的影响进行观察分析。方法将本院2011年4月-2013年4月收治的90例早期糖尿肾病患者随机分为观察组与参考组,各为45例,观察组患者采用厄贝沙坦300 mg治疗,参考组患者采用厄贝沙坦150 mg治疗,分别在治疗前、治疗后3个月对患者血压、血肌酐、尿白蛋白排泄率、血清钾及血尿素氮含量进行观察,记录患者治疗期间不良反应发生情况。结果两组患者治疗期间血压均出现一定程度降低（P〈0.05）,但是组间比较差异无统计学意义（P〉0.05）;相较治疗前两组患者尿白蛋白排泄率均有明显下降（P〈0.05）,观察组下降程度大于参考组（P〈0.05）;两组患者血肌酐及血尿素氮与治疗前比较差异无统计学意义（P〉0.05）;两组患者不良反应发生率比较差异无统计学意义（P〉0.05）。结论大剂量厄贝沙坦在早期糖尿病肾病治疗中降低微量尿白蛋白方面效果更加显著,较好保护肾脏,同时毒副作用少,可在临床参考使用。     

Pharmacoeconomic aspects of losartan treatment to delay progression of renal disease in patients with Type 2 diabetes

There is growing evidence from clinical trials that losartan (Avastar^?, Merck & Co., Inc.) and other angiotensin (A)-II-receptor antagonists have beneficial effects on the progression of renal disease among Type 2 diabetic patients beyond the benefits derived from the effect of blood-pressure lowering alone. Comparators used is the studies were not angiotensin-converting enzyme-inhibitors but typically conventional hypertensive therapy plus placebo, placebo alone and in one case, amlodipine. These trials have reported reductions in progression to end stage renal disease (ESRD) (losartan and irbesartan) and to nephropathy (irbesartan). An important pharmacoeconomic question is whether potential cost-savings on reduced progression to ESRD and nephropathy outweigh the extra costs of A-II-antagonist treatment. This paper will review the published economic studies for A-II-receptor antagonists and their pharmacoeconomic implications. In particular, potential pharmacoeconomic implications and related methodological aspects of the recent RENAAL trial for losartan are considered.     

The value of irbesartan in the management of hypertension

Elevated blood pressure levels are highly prevalent and are a major reason for cardiovascular events and thus place a significant financial burden on healthcare systems worldwide. Guidelines recommend five first-line anti-hypertensive drug classes, but compelling indications may indicate favoring one drug class over another. Angiotensin receptor blockers (ARBs) have demonstrated a blood pressure lowering efficacy which is at least comparable with other drug classes, including ACE inhibitors (ACE-I), β-blockers, calcium channel blockers and diuretics. They have, in addition, a lower side effect profile than other drug classes and patients on ARBs are more persistent with therapy. Compelling indications for the use of ARBs are heart failure, post-myocardial infarction, diabetic nephropathy, proteinuria/microalbuminuria, left ventricular hypertrophy, atrial fibrillation, metabolic syndrome and ACE-I induced cough. The ARB irbesartan has demonstrated a high efficacy in lowering blood pressure, which has been shown to be at least comparable with ACE-Is and superior to other ARBs such as losartan and valsartan. This translated into a better cost-effectiveness for irbesartan than for valsartan and losartan in the treatment of hypertension. In addition, irbesartan has been shown to be effective in both early and late stage diabetic nephropathy. It has further demonstrated considerable cost savings over standard therapy including β-blockers, diuretics and non-dihydropyridine calcium channel blockers at all stages of kidney disease. Based on efficacy data from the Irbesartan Diabetic Nephropathy Trial and Reduction of Endpoints in NIDDM (non insulin dependant diabetes melitis) with the Angiotensin II Antagonist Losartan Study, it has also demonstrated cost savings over losartan in late stage renal disease. While both losartan and irbesartan are registered for the treatment of late stage diabetic nephropathy, irbesartan is also registered for early stage diabetic nephropathy in the EU. In summary, the data from randomized clinical trials on the efficacy of antihypertensive drugs provides an indication of their real value to patients. In addition observational data from clinical practice and proven end-organ protection in diabetic nephropathy provides further evidence of the true value of irbesartan compared to other ARBs in the treatment of hypertension.     

西格列汀联合厄贝沙坦治疗早期糖尿病肾病的临床效果研究

目的 研究厄贝沙坦联合西格列汀治疗早期糖尿病肾病的临床效果.方法 选择2015年11月至2016年11月接受治疗的早期糖尿病肾病患者90例,患者按照随机数字表达法分为对照组和观察组,每组45例.对照组予以单一的西格列汀治疗,观察组在对照组的治疗基础上增加厄贝沙坦治疗,比较2组患者临床效果[治疗前后血清抑制素C(CysC)、糖化血红蛋白(HbA1c)、尿微量白蛋白(U-mAlb)及24 h尿白蛋白排泄率(UAER)的变化情况]及不良反应的发生情况.结果 2组患者治疗前CysC、HbA1c、U-mAlb、UAER指标差异无统计学意义(P>0.05);治疗后1个月,观察组CysC、HbA1c、U-mAlb、UAER指标下降幅度均高于对照组,差异有统计学意义(P<0.05);治疗后3个月,观察组CysC、HbA1c、U-mAlb、UAER指标的下降幅度均明显高于对照组,差异有统计学意义(P<0.01).2组患者不良反应发生率差异无统计学意义(P>0.05).结论 厄贝沙坦联合西格列汀的治疗方法不仅可以有效改善早期糖尿病肾病患者的肾功能,而且还可对患者的肾脏起到良好的保护作用,值得推广.     

Pharmacoeconomic aspects of losartan treatment to delay progression of renal disease in patients with Type 2 diabetes

There is growing evidence from clinical trials that losartan (Cozaar, Merck & Co., Inc.) and other angiotensin (A)-II-receptor antagonists have beneficial effects on the progression of renal disease among Type 2 diabetic patients beyond the benefits derived from the effect of blood-pressure lowering alone [corrected]. Comparators used is the studies were not angiotensin-converting enzyme-inhibitors but typically conventional hypertensive therapy plus placebo, placebo alone and in one case, amlodipine. These trials have reported reductions in progression to end stage renal disease (ESRD) (losartan and irbesartan) and to nephropathy (irbesartan). An important pharmacoeconomic question is whether potential cost-savings on reduced progression to ESRD and nephropathy outweigh the extra costs of A-II-antagonist treatment. This paper will review the published economic studies for A-II-receptor antagonists and their pharmacoeconomic implications. In particular, potential pharmacoeconomic implications and related methodological aspects of the recent RENAAL trial for losartan are considered.     

Economic evaluation of ACE inhibitor treatment of nephropathy in patients with insulin-dependent diabetes mellitus in Italy

Diabetic nephropathy is one of the major complications of insulin-dependent diabetes mellitus (IDDM), with proteinuria being the main clinical manifestation of diabetic nephropathy. Most patients who develop overt proteinuria progress to end-stage renal disease (ESRD), usually within 5 to 7 years; ESRD necessitates dialysis or renal transplantation. Although a relationship between blood pressure reduction and delaying of ESRD has been assumed for a long time, only recently has a controlled randomised clinical trial shown that the treatment of diabetic nephropathy with an ACE inhibitor can significantly delay the loss of renal function and, therefore, ESRD. Consistent with the clinical trial on which this economic evaluation was based, the costs and consequences of 2 alternatives were considered: (i) patients subject to blood pressure control with only antihypertensive medication, but without an ACE inhibitor (placebo group) and (ii) patients given ACE inhibitor therapy (captopril group) with similar blood pressure control to the placebo group. This cost-effectiveness analysis was performed from the perspective of the Italian National Health Service [Servizio Sanitario Nazionale (SSN)]. Accordingly, only direct costs related to publicly funded healthcare services were included. The number of dialysis-years avoided (DYA) was the clinical end-point. A 10-year time horizon was considered for the economic evaluation. Captopril therapy was dominant, being at the same time more effective and less costly. The total cost for the captopril alternative during the 10-year period was 21,901,625 Italian lire (L; 1993 values) per patient, while total cost for the placebo alternative was L30,352,590 per patient. Compared with placebo, 20.01 DYA per 100 patients treated were estimated with captopril therapy during the trial period, equivalent to 2.4 months per patient. The robustness of this result was confirmed by sensitivity analysis: for both extremes, captopril remained dominant. This economic evaluation, requested by the Italian Ministry of Health, demonstrated savings in healthcare expenditure with the use of an ACE inhibitor in patients with proteinuria.     

丹红注射液联合厄贝沙坦治疗早期糖尿病肾病的疗效观察

目的观察丹红注射液联合厄贝沙坦治疗早期糖尿病肾病的疗效。方法64例早期糖尿病肾病患者按数字表法随机分为观察组及对照组各32例,两组均给予控制血糖、改善肾功能等治疗,观察组同时加用丹红注射液、厄贝沙坦治疗,2周后评价疗效。结果观察组总有效率（87．5％）优于对照组（59．4％）（X^2=6．38,P〈0．05）,治疗12周后,两组尿蛋白均较治疗前明显减少（t=2．42、2．65,均P〈0．05）,其中观察组尿蛋白[（0．6±0．1）g／24h]下降程度明显优于对照组[（0．7±0．3）g／24h]（t=2．74,P〈0．05）。两组均未发生严重不良反应。结论丹红注射液联合厄贝沙坦治疗早期糖尿病肾病疗效好,可降低尿微量白蛋白,值得临床推广应用。