大剂量缬沙坦联合雷米普利治疗早期糖尿病肾病的临床观察

目的：探讨大剂量血管紧张素受体拮抗剂联合血管紧张素转换酶抑制剂治疗早期糖尿病肾病的疗效和安全性。方法：将60例患者随机分成2组，缬沙坦组（n=30）服用缬沙坦（valsartan）320mg／d，联合组（n=30）服用雷米普利（Ramipril）10mg／d联合缬沙坦160mg／d，疗程6个月。观察治疗前后两组收缩压（SBP）、舒张压（DBP）、24h尿白蛋白、血钾、肾功能（BUN、Cr）及不良反应情况。结果：两组在治疗前后均能有效降低血压，联合组降舒张压优于缬沙坦组；治疗前后24h尿白蛋白定量均有所下降，差异具有显著性（P〈0．05），而联合组效果更为明显；两组治疗前后血钾、肾功能差异无显著性（P〉0．05）。结论：大剂量血管紧张素受体拮抗剂联合血管紧张素转换酶抑制剂治疗早期糖尿病肾病安全，联合治疗双重阻断肾素血管紧张素系统有叠加的减少尿蛋白及降血压作用。

Clinical Study of High Dose Valsartan Combined with Ramipril in Treatment of Diabetic Nephropathy in Early Stage

Objective:To investigate the effect and safety of high dose valsartan combined with ramipril in treatment of patients with diabetic nepbropathy in early stage.Methods:60 cases of diabetic nephropathy were randomly divided into two groups,including valsartan group with 320 mg/d(n=30)and ramipril 10mg/d plus valsartan 160 mg/d in combination group (n=30)over six months.Blood pressure,urinary albumin,serum creatine,BUN,serum potassium and adverse effects were detected during the trial.Result:After treatment,systolic blood pressure(SBP),diastolic pressure(DBP)and 24 hours urinary albumin decreased in both groups(P<0.05).Combined ACEI(angiotensin converting enzyme inhibitor) and ARB(angiotensin receptor blocker) had better effect in DBP and proteinuria reduction,but no statistical diference.Serum potassium and renal function had no statistical diference between before and after treatment of two groups(P>0.05).Conclusion:High dose or combination administration have good effect and safety in the treatment of early diabetic nephropathy.Combination treatment have better effect of lowering blood pressure and proteinuria.