螺内酯治疗2型糖尿病肾病的临床研究

【目的】探讨使用螺内酯治疗2型糖尿病肾病的安全性及其对蛋白尿的影响。[方法]40例2型糖尿病肾病患者，在前期服用降压药基础上[包括最大推荐剂量ACEI和（或）ARB]，随机平均分为螺内酯组和安慰剂组．分别予螺内酯20mg／d及同等剂量安慰剂治疗。并定期测量患者血压、24h尿蛋白定量及生化指标。【结果】10周后，两组患者中分别有3人因其基础血钾、血肌酐较高，相继出现高血钾并退出试验，12周后．螺内酯组患者24h尿蛋白定量较安慰剂纽明显下降（P〈0．05），而血压、肾小球滤过率（GFR）无明显差异（P〉0．05）。【结论】对于早期2型糖尿病肾病患者，在ACEI和（或）ARB治疗基础上，加用小剂量螺内酯治疗是安全的．并有肾脏保护作用。

Clinical Research on Type 2 Diabetic Nephropathy Treated by Spironolactone

[Objective]To investigate the safety and the effect of spironolactone on proteinuria of type 2 diabetic nephropathy. [Methods]Forty type 2 diabetic patients with nephropathy who received antihypertens ive treatment （maximally recommended doses of ACE inhibitor and/or ARB） were divided into spironolactone group（ treated with spirono[actone 20 mg once daily） and placebo group（administrated with matched placebo）. The blood pressure, 24b proteinuria and biochemical parameters were measured at regular intervals. [Results] After 10 weeks, 3 paucnts of each group developed hypcrkalemia and had to be excluded. Compared to other patients, their baseline serum creatinine and potassium concentrations were elevated. After 12 weeks, in compairison with placebo group, spironolactone aignificantly decreased 24h proteinuria, but blood pressure and glomerular fihration rate did not differentiate notably. [Conclusion]To type 2 diabetic patients with early ne phropathy, low-dose spironolactone combined with ACEI and or ARB is safe and has the protective effcct on renal function.