替米沙坦对早期糖尿病肾病患者血浆同型半胱氨酸及颈动脉内膜中层厚度的影响

目的观察替米沙坦对早期糖尿病肾病(DN)患者临床血生化指标及血浆同型半胱氨酸(Hcy)、颈动脉内膜中层厚度(IMT)的影响。方法将60例血压正常的早期2型DN患者按随机数字表法分为替米沙坦组和常规治疗组,各30例。两组均给予常规治疗,替米沙坦组另给予替米沙坦40 mg/d,疗程为24周。比较两组治疗前和治疗24周后尿清蛋白排泄率(UAER)、糖化血红蛋白(HbA1c)、血脂、胰岛素抵抗指数(HOMA-IR)、血浆Hcy水平及颈动脉IMT的变化。结果治疗后,替米沙坦组较常规治疗组UAER〔(61±26)mg/L与(98±38)mg/L〕、HO-MA-IR〔(3.17±0.66)与(3.60±0.87)〕、血浆Hcy水平〔(11.7±2.9)μmol/L与(14.4±2.8)μmol/L〕显著下降(P<0.05);替米沙坦组治疗后较治疗前颈动脉IMT〔(0.88±0.20)mm与(0.99±0.24)mm〕显著降低(P<0.05)。多元线性回归分析显示,UAER与Hcy(β=0.383,P<0.01)、病程(β=0.340,P<0.01)、颈动脉IMT(β=0.224,P<0.01)及HOMA-IR(β=0.201,P<0.01)呈线性回归关系。结论替米沙坦能改善早期DN患者胰岛素抵抗,降低血浆Hcy水平及颈动脉IMT,减少UAER,具有独立于降压之外的肾脏保护作用,并能延缓动脉粥样硬化进展。

Effect of Telmisartan on the Levels of Serum Homocysteine and Carotid Intima-Media Thickness in Patients with Early Diabetic Nephropathy

Objective To investigate the effects of telmisartan on the blood biochemical indexes,the levels of serum homocysteine(Hcy) and carotid intima-media thickness(IMT) in patients with early diabetic nephropathy(DN).Methods 60 patients with early type 2 DN and normal blood pressure were randomly divided into telmisartan group and routine treatment group according to random digital table with each group 30 cases.The two groups were both given routine treatment.The telmisartan group was given telmisartan 40 mg/d in addition and the course of treatment was 24 weeks.The UAER,HbA1c,blood lipid,insulin resistance index(HOMA-IR),serum Hcy and carotid IMT before treatment and 24 weeks after treatment were compared between the two groups.Results After treatment,the levels of UAER((61±26)mg/L VS(98±38)mg/L),HOMA-IR((3.17±0.66) VS(3.60±0.87)) and Hcy((11.7±2.9)μmol/L VS(14.4±2.8)μmol/L) in telmisartan group were significantly decreased compared with those of the routine treatment group(P<0.05).The level of carotid IMT in telmisartan group((0.88±0.20) mm VS(0.99±0.24)mm) was significantly decreased compared with that before the treatment(P<0.05).Multiple linear regressions analysis showed that there was correlation between UAER and Hcy(β=0.383,P<0.01),course of disease(β=0.340,P<0.01),carotid IMT(β=0.224,P<0.01) and HOMA-IR(β=0.201,P<0.01).Conclusion Telmisartan can improve insulin resistance of patients with early DN,significantly reducing the levels of UAER,the serum levels of Hcy and carotid IMT.It has kidney protection effect independent of its antihypertensive effect and can delay the development of atherosclerosis.