依那普利联合左旋氨氯地平治疗2型糖尿病肾病临床观察

目的:探讨血管紧张素转换酶(ACE)抑制剂(依那普利)和长效钙离子拮抗剂(左旋氨氯地平)对2型糖尿病肾病的疗效。方法:将42例糖尿病肾病患者。随机分为主组:左旋氨氯地平组(14例),依那普利组(14例),及两药联合治疗组(14例)。3组在治疗糖尿病的基础上,分别服用依那普利5mg,左旋氨氯地平2.5mg,清晨口服,每日1次,如果治疗2周后血压仍未降至正常(>104/90mmHg),依那普利加至10mg,左旋氨氯地平增加至5mg。两药联合治疗组同时服用依那普利5mg和左旋氨氯地平2.5mg,共用12周。结果:两药单独治疗均可明显降低糖尿病肾病高血压(P<0.01),减少24h尿蛋白排出(P<0.05)。结论:依那普行和左旋氨氯地平治疗糖尿病肾病所致的高血压均有较好的降压作用,且能减少24h尿蛋白的排泄。两药联合治疗疗效相加。

Therapeutic Effect of Levamlodlpine and Enalapril for type 2 Diabetes and Impaired Renal Function.

Objective:To study the effect of a long-acting calcium antagonist(levamlodipine) and angiotensin converting enzyme(ACE) inhibitor(enalapril) in IDDM patients with diabetic nephropathy.Methods: Fohty-two(27 males and 15 females,mean age is(56±4) years patients with nor-insulin-dependent diabetes mellitus,hypertension,renal insufficiency,and macroalbuminuria.Patients were randomly divided into three groups to a twelve weeks double blind treatment phase with the two study drugs.Levamlodipine and enalapril were started at a dose of 2.5mg and 5mg once daily in the morning respectively.If the blood pressure measured before the morning dose of the study drugs remained>140/90 mmHg,the doses were then up-titrated after two weeks to levamlodipine 5mg/d and enalapril 10mg/d respectively.Results: with treatment,bood pressures in all groups were significantly reduced(P<0.01),the urinary albumin excretion rate was decreased in all groups(P<0.05).The fall rate in combination of two drugs in a more pronounced decreased in blood pressure and albuminuria(P<0.01).Conclusions:This study showed that in hypertensive microalbuminuric type Ⅱdiabetic patients,the combination of levamlodipine plus enalapril resulted in a move pronounced in blood pressure and a greater redution in urinary albumin excretion than either agent alone.This combination strategy should thus be a more effective tool for obtaining optimal blood pressure control in patients with diabetic nephropathy.