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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ACE1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)、HbA_1c、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 υs 46.9±19.8,P<0.01);治疗后UAER(mg/24 h)A组较B组低(17.4±8.2υs 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 71～200μg/min组。
Objective To compare the efficacy of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in different stages of early diabetic nephropathy (DKD). Methods 87 patients with early DKD were randomly divided into A and B groups according to their different stages. Patients in A and B groups were randomly divided into ACE1 group, ARB group, ACEI + ARB group and ACEI group. Patients in ACEI group received 10 mg / d, ARB group took irbesartan 150 mg / d, ACEI + ARB group took losartin 5 mg / d + irbesartan 75 mg / d for 12 weeks. Before and after treatment, blood pressure, blood urea nitrogen, creatinine, 24-hour urinary albumin excretion rate (UAER), HbA_1c, glomerular filtration rate (GFR) and so on. Results In different stages of early DKD, the UAER in both groups A and B decreased significantly (P <0.01), and the combined treatment group was significantly lower than the single use group (P <0.01). The time of reaching the standard in group A was less than that in group B (13.9 ± 4.2 υs 46.9 ± 19.8, P <0.01). The UAER (mg / 24 h) in group A was lower than that in group B (17.4 ± 8.2υs 21.2 ± 5.1) after treatment. Conclusion The effect of half dose of ARB combined with half dose of ACEI on DKD patients is better than monotherapy. UAER 20 ~ 70 μg / min group is superior to UAER 71 ~ 200 μg / min group.