双重阻断肾素-血管紧张素系统对早期糖尿病肾病的影响

目的观察血管紧张素转换酶抑制剂(ACEI)联合血管紧张素受体Ⅱ拮抗剂(ARB)治疗早期糖尿病肾病(DN)的疗效。方法将76例早期糖尿病肾病患者随机分为ACEI组、ARB组及联合治疗组,ACEI组患者给予依那普利治疗,ARB组患者给予氯沙坦治疗,联合治疗组患者给予依那普利联合氯沙坦治疗。观察治疗前及治疗12周后3组患者糖化血红蛋白(HbA1c)、血压、尿微量清蛋白排泄率(UAER)、血K 及肾小球滤过率(GFR)变化。结果治疗前3组患者HbA1c、收缩压(SBP)、舒张压(DBP)、UAER、GFR和血K 间差别无统计学意义(P>0.05),而治疗后联合治疗组患者SBP、UAER与ACEI组、ARB组比较,差别有统计学意义(P<0.05)。结论ACEI和ARB联合治疗可以双重阻断肾素-血管紧张素系统,有更强的降低UAER和收缩压的作用。

Dual Blockage of Renin-Angiotensin System in Patients with Early Diabetic Nephropathy: A Study of Randomized Control Trial

Objective To observe the effect of angiotensin-converting enzyme inhibitor(ACEI) combined with angiotensin receptor blocker(ARB) on early diabetic nephropathy(DN).Methods A randomized controlled trial was carried out in seventy-six patients with early diabetic nephropathy,who were divided into ACEI group,ARB group and a combined group.The ACEI group were given enalapril,and the ARB group losartan;The combined group received therapy of both enalapril and losartan.Clinical data was collected at baseline and after 12 weeks of treatment..Results There were no significant differences in hemoglobin 1c(HbA_ 1c),blood pressure,urinary microalbumin excretion rate(UAER),glomerular filtration rate(GFR),and blood K among the three groups before treatment(P>0.05);After 12-week therapy,the combined group were significantly different from ACEI group and ARB group in SBP and UAER(P<0.01).Conclusion Treatment of ACEI combined with ARB can dually block Renin-Angiotensin System,and strongly lower UAER and contractive pressure.