厄贝沙坦治疗2型糖尿病早期肾病的临床观察

目的：探讨厄贝沙坦对2型糖尿病早期肾病尿白蛋白、转铁蛋白的影响。方法：将36例入选患者随机分为三组，A组血压正常，仅用降糖药治疗；B组血压正常，降糖基础上给厄贝沙坦（75mg／d）；C组伴高血压，降糖基础上加厄贝沙坦，随访血压、24h尿白蛋白排泄量（24hUAlb），24h尿转铁蛋白（24hUTRF）等。结果：3个月后，A组24hUAlb、24hUTRF及平均脉压（MAP）均无明显变化（P〉0．05）；B组24hUAlb、24hUTRF显著降低（P〈0．05），MAP无显著变化（P〉0．05）；C组24hUAlb、24hUTRF及MAP均显著降低（P〈0．05），且24hUAlb减少与MAP下降无相关性。结论：厄贝沙坦对2型糖尿病早期肾病有独立于降压作用之外的肾脏保护作用，且无明显副作用。

Therapeutic Effect of Irbesartan (an ARB) on Early Nephropathy in Patients with DM2

Objective To study the effect of irbesartan treatment on urinary albumin and transferrin excretion in patients with type 11 diabetes mellitus （DM2）. Methods Early nephropathy was defined as 24h urinary albumin excretion amount 30 ～300mg with some degree of retinopathy. In this study, 36 DM2 patients with early nephropathy fell into 3 groups： Group A： normotensive, treated with hypoglyeemie agent only , n = 13, Group B： normotensive, irbesartan 75mg/d was added to the treatment regimen, n = 12, Group C： hypertensive, irbesartan 75 ～ 300mg/d added, n = 11. The 24h urinary excretion of albumin, transferrin, median arterial pressure （MAP）, blood HbAle, urea nitrogen and ereatinine in all subjects were examined both before and after the three months＇ treatment course. Results In Group A, the 24h urinary excretion of albumin, transferrin and MAP changed little after 3 months. In Group B, the 24h urinary excretion of albumin and transferrin decreased significantly （ vs be.for treatment, P 〈 0. 05 ） while MAP changed little. In Group C, 24h urinary excretion of albumin, transferrin and MAP all decreased significantly after 3 months＇ treatment （P 〈0.05）. There was no correlation between the decrease of 24h urinary albumin excretion and decrease of MAP. Conclusion There seems to be an independent renal protective effect besides the hypotensive effect of irbesartan in patients with DM2.