·糖尿病性肾脏疾病·

　　杜培洁 秦贵军 栗夏莲

　　作者单位：450052郑州大学第一附属医院内分泌科

　　通讯作者：秦贵军

　　【摘要】 目的 比较血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)在早期糖尿病性肾脏疾病(DKD)不同阶段的疗效。 方法 87例DKD 早期患者按其不同阶段随机分为A、B两组，将A、B两组患者分别随机分为ACEI组、ARB组、ACEI+ARB组，ACEI组服用洛丁新10 mg/d、ARB组服用厄贝沙坦150 mg/d、ACEI+ARB组服用洛丁新5 mg/d+厄贝沙坦75 mg/d，疗程12周，比较治疗前后血压、血尿素氮、肌酐、24小时尿白蛋白排泄率(UAER)、HbA1c、肾小球滤过率(GFR)等的变化。 结果 在早期DKD 不同阶段，A、B两组治疗前后UAER均明显下降(P<0.01)，且联合治疗组明显低于单用组(P<0.01)。A 组达标时间(d)小于B组(13.9±4.2 vs 46.9±19.8，P<0.01);治疗后UAER(mg/24 h)A组较B组低(17.4±8.2 vs 21.2±5.1)。 结论 对于DKD患者半量ARB联合半量ACEI 治疗疗效优于单药治疗;UAER 20~70 μg/min组疗效优于UAER 71~200 μg/min组。

　　【关键词】血管紧张素转换酶抑制剂;血管紧张素受体拮抗剂;糖尿病性肾脏疾病早期

　　doi:10.3969/j.issn.1006-6187.2011.04.007

　　Comparison of therapeutic efficacies among ACEI，ARB and the combined ACEI and ARB in diabetic patients with urinary albumin excretion rate (UAER) of 20-70 μg/min

　　DU Pei-jie，QIN gui-jun，LI Xia-lian. Department of Endocrinology，the First Affiliated Hospital，Zhengzhou University，Zhengzhou 450052，China

　　Corresponding author: QIN Gui-jun

　　【Abstract】 Objective To investigate the therapeutic efficacies of ACEI，ARB and the combined ACEI and ARB in diabetic patients with UAER of 20-70 μg/min (group A)versus 71-200 μg/min (group B). Methods The subgroups of group A and B included ACEI (benazepril 10 mg/d)，ARB (irbesartan 150 mg/d)and ACEI plus ARB treatment(benazepril 5 mg/d +irbesartan 75 mg/d)for 12 weeks. The changes of blood pressure，blood urea nitrogen (BUN)， serum creatinine (SCr)，24-h urinary albumin excretion rate(UAER)，HbA1c，glomerular filtration rate (GFR)were observed before and after treatment. Results The UAER decrements were more in combination therapy than in any single therapy in both group A and B(all P<0.05)，and was more in group A than in group B(P<0.05).Group A took (13.9±4.2) days and group B took (46.9±19.8) days (P<0.01) to get UAER<20 μg/min after treatment. Conclusions The therapeutic effects in half dosage of ACEI plus ARB group are superior to those in groups of single ACEI or ARB， and those in group of UAER of 20-70 μg/min are superior to those in group of UAER of 71-200 μg/min.

　　【Key words】Angiotensin-converting-enzyme inhibitor;Angiotension Ⅱ receptor blocker;Diabetic kidney disease，early stage