普伐他汀与福辛普利联用降低糖尿病肾病患者尿蛋白和血浆内皮素水平的观察研究

目的　探讨福辛普利 (蒙诺 )和普伐他汀 (普拉固 )联用降低糖尿病肾病 (DN)患者 2 4h尿蛋白和血浆内皮素 (ET)水平的临床疗效。方法　参照Mogensen的DN分期标准 ,将 78例DN患者分为早期DN(A1组和A2组 )和临床期DN(B1组和B2组 ) ,A1和B1两组为能够配合治疗的DN患者 ,A2和B2两组为不能坚持服用普伐他汀配合治疗的DN患者。观察治疗前后患者血糖、血脂、血压、2 4h尿蛋白及ET水平的变化。结果　在血糖、血压控制较好的基础上 ,4组DN患者治疗后 2 4h尿蛋白及血浆ET水平均有不同程度的下降 ,但A2、B2组血脂水平的下降不如A1和B1组明显 (P <0 .0 1和 0 .0 5 ) ,血糖控制较A1和B1组稍差 ,但差异无显著性(P >0 .0 5 )。结论　在严格控制血糖的基础上 ,福辛普利能够控制早期和临床期DN患者的血压 ,且能明显减少2 4h尿蛋白并降低血浆ET水平 ;福辛普利与普伐他汀联用的降压、减少尿蛋白和降低血浆ET水平的效果更好。

Study on lowering the levels of urinary protein and serum endothelin in patients with diabetic nephropathy by combined use of monopril and pravastatin

Objective To study the effect of lowering the levels of urinary protein and serum endothelin by combined use of monopril and pravastatin, and to observe changes of blood sugar and blood lipid levels, blood pressure, 24 h serum endothelin(ET) and urinary protein before and after the treatment. Methods 78 diabetic nephropathy(DN) patients were divided into four groups (A 1, A 2, early DN and B 1, B 2 clinical DN) according to the staging criteria of Mongensen. Group A 1 and B 1 DN patients were cooperative with the physician, group A 2 and B 2 DN patients were unable to take pravastatin continuously. Results On the basis of better control of the blood glucose and the blood pressure, 24 h urinary protein and serum ET of all four groups decreased to a certain extent, but lowering of blood lipid after treatment in group A 1 and B 1 was more significant than that in group A 2 and B 2( P <0.01), the reduction of 24 h urinary protein and serum ET in group A 1 and B 1 were more apparent than those in group A 2 and B 2. Conclusion On basis of strict control of blood sugar, monopril is able to control the blood pressure and reduce 24 h urinary protein and serum ET in early and clinical DN patients. When the two drugs are used in combination, the antihypertensive effect and reduction of urinary protein and serum ET levels are even more significant.