福辛普利和氯沙坦单用或合用治疗早期糖尿病肾病90例

目的:探讨福辛普利联合氯沙坦对早期糖尿病肾病的治疗作用。方法:90例合并早期糖尿病肾病的2型糖尿病病人,随机分为3组。维持原治疗不变,福辛普利组加用福辛普利10mg,po,qd,氯沙坦组加用氯沙坦50mg,po,qd,合用组加用福辛普利与氯沙坦,用法同前2组,疗程均为12wk。观察治疗前后尿清蛋白排泄率(UAER)、糖化血红蛋白(HbA1c)、肾功能、平均动脉压(MAP)等指标的变化。结果:3组治疗后,UAER均下降(P<0.01),合用组下降幅度大于福辛普利组和氯沙坦组[(76±39)mg·24h-1,vs(55±36),(46±42)mg·24h-1,P<0.05]。各组治疗后MAP均降低(P<0.01),各组间治疗后血压水平差异无显著意义(P>0.05)。结论:福辛普利氯沙坦均可降低早期糖尿病肾病病人的蛋白尿,且联合应用显示协同作用,肾素血管紧张肽系统药物具有独立于降血压之外的肾脏保护作用。

Monotherapy or combination therapy with fosinopril and losartan in 90 patients with early diabetic nephropathy

AIM:To study the effects of combination of fosinopril and losartan in treating early diabetic nephropathy. METHODS:Ninty patients of type 2 diabetes mellitus (DM) with early diabetic nephropathy were randomly divided into three groups. All patients were kept on previous management of DM. The patients in the fosinopril group were treated with fosinopril 10 mg daily, the losartan group with losartan (50 mg) daily and the combination group with fosinopril (10 mg) and losartan 50 mg daily. Period of treatment for all groups was 12 wk. Urinary albumin excretion rate (UAER), glycohemoglobin A_(1c) (HbA_(1c)), blood urea nitrogen(BUN), serum creatinine (Scr) , uratic acid (UA), the mean arterial pressure (MAP) were observed before and after the treatment. RESULTS: UAER after treatment of three groups were all decreased (P<0.01). Interestingly, reduction of UAER was remarkable in the combination group[(76±(39) mg)·24 h~(-1),vs (55±36),(46±42) mg·(24 h~(-1)),(P<(0.05]).) HbA_(1c) after treatment in the fosinopril group and the combination group were significantly (decreased)(P<0.05). While, MAP of three groups were also decreased (P<0.01). No significant differences in blood pressure were shown among three groups after the treatment. CONCLUSION: Fosinopril and losantan can lower albuminurea in the patients with early diabetic nephropathy. Furthermore there is a synergism with combination of the two drugs. Besides independent from anti-hypertension effect,renin-angiotensin system drugs also have the renal protective effect.