替米沙坦与阿托伐他汀对老年早期糖尿病肾病患者尿白蛋白排泄率和血清胱抑素C的影响

目的研究替米沙坦联合阿托伐他汀对老年早期糖尿病肾病(DN)患者尿白蛋白排泄率和血清胱抑素C的影响。方法选择65例老年早期DN患者,随机分成2组,替米沙坦组(替米沙坦40 mg/d口服)32例,联合治疗组(替米沙坦40 mg/d+阿托伐他汀20 mg/d口服)33例,进行12周临床观察,比较2组24 h动态血压、血脂、空腹血糖(FBG)、餐后2 h血糖(2 h BG)、血肌酐(Cr)、血清胱抑素C(Cys C)、24 h尿白蛋白排泄率(UAER)的变化。结果经过12周治疗后,2组收缩压、舒张压、三酰甘油(TG)、FBG、CysC、24 h UAER与治疗前比较,有明显好转(P<0.01),联合治疗组UAER、Cys C、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)较替米沙坦组改善更显著(P<0.01),2组FBG、2 h BG差异无统计学意义(P>0.05)。结论替米沙坦治疗早期DN,能有效减少UAER、改善Cys C,可能对延缓早期DN的进展有益,联合阿托伐他汀对肾保护作用更显著。

The effects of telmisartan and atorvastatin on UAER and Cys C in older patients with early diabetic nephropathy

Objective To investigate the effects of telmisartan and atorvastatin on the levels of 24 h urine albumin excretion rate （ UAER ） and serum cystatin C （ Cys C ） in older patients with early diabetic nephropathy （DN）. Methods Sixty five consecutive older patients with early diabetic nephropathy were randomly assigned to telmisartan treatment group （40 mg/d, po） , and telmisartan （40 rag/d） plus atorvastatin （20 mg/d, po） treatment group for 12 weeks. The 24h blood pressure monitor, serum lipids ,fasting blood glucose （FBG） ereatine（ Cr）, UAER and Cys C were observed pre and post treatment, and compared intra groups. Results After 12 weeks treatment, the systolic blood pressure （SBP） , diastolic blood pressure （DBP） , FBG, UAER, Cys C, triglyeride （TG） were significantly improved in both groups （ P 〈 0.01 ）. The combination treatment group demonstrated greater improvement in UAER, Cys C, cholesterol（TC）, high density lipoprotein （HDL） and low density lipoprotein（ LDL）, compared with telmisartan treatment group（ P 〈 0.01 ）. The level of FBG,2 h BG decreased in two groups,but no significant difference was observed （ P 〉 0.05 ）. Conclusion It concluded that applying telmisartan in treatment early diabetic nephropathy could decrease the levels of UAER and improve Cys C, and it had benefit for delaying the progression of early diabetic nephropathy. It would be more remarkable protection effect on kidney once combination with atorvastatin.