厄贝沙坦联合雷米普利治疗早期糖尿病肾病的临床观察

目的：观察厄贝沙坦联合雷米普利治疗早期糖尿病肾病的疗效及安全性。方法：将150例糖尿病肾病患者随机均分为对照组和观察组。对照组患者给予厄贝沙坦150mg，qd，口服，若血压未达标准则剂量加倍；观察组患者在对照组治疗的基础上给予雷米普利5mg，qd，口服，若血压未达标准则剂量加倍。两组患者疗程均为12周。比较两组患者的临床疗效；观察所有患者治疗前后的血压、24h尿蛋白量、尿微量白蛋白排泄率（UREA）、血肌酐（SCr）、血电解质钾（K^＋）、血清光抑素C（CysC）、内生肌酐清除率（Ccr）及不良反应的发生情况。结果：观察组患者的总有效率显著高于对照组，两组比较差异有统计学意义（P〈0.05）。两组患者UREA、24h尿蛋白、CysC均显著低于同组治疗前，且观察组显著低于对照组，差异均有统计学意义（P〈0.05），但两组患者的Ccr治疗前、后及组间比较差异无统计学意义（P〉0．05）。两组患者不良反应发生率比较，差异无统计学意义（P〉0.05）。治疗期间两组患者血压、K^＋、SCr均无明显变化，且无严重不良反应发生。结论：厄贝沙坦联合雷米普利治疗早期糖尿病肾病疗效显著，能有效地延缓肾功能衰竭，且不良反应少，安全性较好。

Clinical Observation of Irbesartan Combined with Ramipril for Early Diabetic Nephropathy

OBJECTIVE： To explore the clinical efficacy and safety of ramipril combined with irbesartan for early period diabetic nephropathy （DN）. METHODS： 150 patients with DN were selected and randomly divided into control group and observation group. Control group was irbesartan 150 mg, qd, p.o., or bid （if the blood pressure didn＇t reach the standard）. Observation group was given ramipril 5 mg, qd, p.o., or bid （if the blood pressure）. Treatment course of 2 groups lasted for 12 weeks, clinical effica- cies of all patients were evaluated. Blood pressure, 24 h urinary protein, UREA, SCr, K^＋, CysC and Ccr of all patients were determined; the occurrence of ADR was observed. RESULTS： The total effective rate of observation group was significantly higher than that of control group; there was statistical significance （P〈0.05）. UREA, 24 h urinary protein and CysC of 2 groups were significantly lower than before, and observation group were lower than control group; there was statistical significance （P〈0.05）. There was no statistical significance in the difference of Ccr between 2 groups before and after treatment （P〉0.05）. There was no statistical significance in the incidence ofADR （P〉0.05）. There was no significant difference in BP, K^＋ and SCr between 2 group, and no severe ADR was found. CONCLUSIONS： Irbesartan combined with ramipril is effective for the treatment of early DN and can relieve renal failure effectively with few ADR.