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目的观察血管紧张素 1型受体拮抗剂 (AT1 Ra)缬沙坦对伴微量白蛋白尿的早期糖尿病肾病的治疗作用。方法 64例 2型糖尿病患者 ,2 4小时尿白蛋白排泄率 (2 4h UAER) 2 0～ 2 0 0μg/ min,伴或不伴高血压 ,维持原糖尿病治疗不变 ,分组比较应用缬沙坦 (80mg/ d)或贝那普利 (10 mg/ d)治疗 8周前后平均动脉压 (MAP)、2 4h UAER、Hb A1 c、尿酸 (UA)等指标的变化。结果血压正常的缬沙坦治疗组和贝那普利治疗组 2 4h UAER分别由 (4 9.4± 2 5 .4)μg/ min降至 (3 4.9± 2 0 .4)μg/ min(P<0 .0 1)和由 (4 8.4± 2 6.9)μg/ min降至 (3 3 .5± 19.7)μg/ min(P<0 .0 1)。伴高血压的缬沙坦治疗组 2 4h U AER由 (68.6± 3 4.8)μg/ min降至 (5 0 .3± 3 6.6)μg/min(P<0 .0 1) ;伴高血压的贝那普利治疗组 2 4h UAER由 (66.7± 3 1.0 )μg/ min降至 (4 8.0± 2 5 .6)μg/ min(P<0 .0 1) ,二者疗效相似 ,且均与血压变化不相关。结论 ATl Ra缬沙坦可以降低早期糖尿病肾病的蛋白尿 ,其肾脏保护作用除了与降血压有关 ,还有不依赖降压效应的其他机制
Objective To observe the therapeutic effect of valsartan, an angiotensin receptor type 1 receptor antagonist (AT1 Ra), on early diabetic nephropathy with microalbuminuria. Methods Sixty-four patients with type 2 diabetes mellitus were enrolled in this study. 24 hours urinary albumin excretion rate (24 hours UAER) 20 ~ 200 microg / min, with or without hypertension, (MAP), 24 h UAER, Hb A1c, uric acid (UA) were measured before and after treatment with 80 mg / d or 10 mg / d of benazepril. Results The 24 h UAER in valsartan group and benazepril-treated group decreased from (44.4 ± 2.5) μg / min to (34.9 ± 2.04) μg / min, respectively, P < 0 .0 1) and decreased from (4 8.4 ± 2 6.9) μg / min to (3 3 .5 ± 19.7) μg / min (P <0.01). The UAER at 24 hours after valsartan treatment with hypertension was decreased from (68.6 ± 3 4.8) μg / min to (50.3 ± 3 6.6) μg / min (P0.01) The 4-hour UAER in benazepril treatment group decreased from (66.7 ± 3 1.0) μg / min to (4. 8.0 ± 2.56) μg / min, P <0.01) No change in blood pressure. Conclusion ATl Ra valsartan can reduce the proteinuria of early stage diabetic nephropathy, and its protective effect on kidneys is related to lowering blood pressure and other mechanisms that do not depend on antihypertensive effect