苯那普利与缬沙坦联用对早期糖尿病肾病的影响

目的观察苯那普利和缬沙坦联合应用对早期糖尿病肾病的保护作用。方法2型糖尿病患者90例，随机分成3组：苯那普利组，缬沙坦组和联合治疗组。观察治疗6个月前后各组患者的血压，24 h尿蛋白排泄率（UAER），血清肌酐（Scr）和尿素氮（BUN），血糖、血脂、糖化血红蛋白（HbA1 c）和血清胰岛素变化。结果单独用苯那普利或缬沙坦，和联合应用两药均可明显降低血压，减少UAER。尽管降低血压各组间对比差异无统计学意义（P〉0.05），但联合应用组降低UAER更明显（P均〈0.05）。各组治疗后血清胰岛素均有明显降低（P均〈0.05），而血糖、血脂、糖化血红蛋白无显著性变化。结论苯那普利联合缬沙坦治疗早期糖尿病肾病，较单独应用这两种药物能更有效地降低血压，减少UAER，阻止或延缓早期糖尿病肾病的发展，也可能通过降低血清胰岛素改善代谢而达到对早期糖尿病肾病的保护作用。

The effect of combination therapy with valsartan and benazepril for early diabetic nephropathy

Objective To observe the effects of combination therapy of valsartan and benazapril in the treatment of early diabetic nephropathy.Methods Ninety patients with diabetic nephropathy were random divided equally into three groups,valsartan treatment group,benazepril treatment group and combination treatment group.After medication for 6 months,the patients underwent examinations for changes in the mean arterial blood pressure(MABP),serum creatinine(Scr),blood urea nitrogen(BUN) and 24 hours urine protein excretion(UAER),blood glucose,serum lipid,glycosylated hemoglobin A1c(HbA1c) and serum insulin(SI).Results Valsartan or benazepril alone or in combination significantly decreased MABP and UAER(P<0.05).In spite of absent significant differences among three groups,combination therapy of the two drugs produced the most obvious reduction of UAER.Valsartan or benazepril did not influence blood glucose,serum lipid and HbA1c,but significantly decreased serum insulin.Conclusion Combined use of valsartan and benazepril may decrease MABP and UAER more than the use of valsartan or benazepril alone.