小剂量苯那普利和缬沙坦联合治老年早期糖尿病肾病

目的前瞻性研究小剂量苯那普利和缬沙坦联合治疗老年早期糖尿病肾病的疗效及合理性。方法120例老年2型糖尿病并早期糖尿病肾病患者随机分为联合治疗组（苯那普利5mg／d＋缬沙坦80mg／d）、苯那普利组（苯那普利10mg／d）和缬沙坦组（缬沙坦80mg／d）各40例，观察期24周。治疗前后检测平均动脉压、尿白蛋白排泄率、内生肌酐清除率、血清肌酐、血清尿素氨、空腹及餐后2h血糖、糖化血红蛋白、血清钾及血脂。结果3组治疗前后血压、血糖、血脂、血清钾差异无显著性，但治疗后尿白蛋白排泄率均较治疗前明显下降（P〈0.05）。各组间比较，联合治疗组尿白蛋白排泄率下降最明显（P〈0．05），缬沙坦组与苯那普利组比较差异无显著性（P〉0．05）。结论小剂量苯那普利和缬沙坦联合治疗老年早期糖尿病肾病疗效显著，安全合理，其肾脏保护作用独立于降血压作用。

Combination therapy with small-dose benazepril plus valsartan for diabetic nephropathy in early stage in elderly patients

Objective To study prospectively the efficacy and rationality of treating early diabetic nephropathy in elderly patients using combination therapy of valsartan and benazepril in half dosage. Methods One hundred and twenty elderly cases of type 2 diabetes with early diabetic nephropathy were randomly divided into three groups. Forty patients were given benazepril 10 mg/d or valsartan 80 mg/d respectively. Another 40 cases were treated with benazepril 5 mg/d combined with valsartan 80 mg/d . Before and after 24 weeks' therapy, the mean arterial pressure (MAP), urinary albumin excretion rate (UAER), endogenous creatinine clearance (CCr), serum creatinine (SCr), blood urea nitrogen (BUN), fasting blood glucose (FBG), 2 h postcibum blood glucose ( 2 h PBG), hemoglobin A1c (HbA1c), serum potassium and blood lipid were determined. Results Before and after therapy, there were no significant differences in FBG, 2 h PBG, HbA1c, SCr, BUN, CCr, MAP, TG, TC, HDL-C, LDL-C and serum potassium among the three groups. UAER in all the groups showed significant decreases after treatments (P<0.01), and decreased mostly in the combinative treatment group (P<0.05). But there were no significant differences between valsartan and benazepril group (P>0.05). Conclusions It is an effective and reasonable way to treat early diabetic nephropathy in elderly patients with combination therapy with valsartan plus benazepril. The protective effects on the kidney is independent from the influence on the blood pressure.