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目的观察氯沙坦对糖尿病肾病合并高血压患者降低尿白蛋白排泄率及降压疗效。方法 6 0例早期糖尿病肾病患者 ,其中 30例伴高血压 ,30例不伴有高血压 ,原糖尿病治疗不变 ,经洗脱期 (停用所有扩血管药物 2周 )后 ,给氯沙坦5 0～ 10 0mg/d口服干预 ,8周后观察 2 4小时动态血压、尿白蛋白排泄率 (UAER)、血肌酐 (Cr)、尿素氮 (BUN)水平的变化。结果治疗后 2 4小时UAER明显下降 (P <0 .0 5 ) ,伴高血压的患者 2 4小时血压下降有显著性 (P <0 .0 5 ) ,血压昼夜下降幅度无显著性 (P >0 .0 5 ) ;不伴高血压的糖尿病肾病患者血压下降无显著性。 2 4小时UAER的下降与血压下降无相关性 (P >0 .0 5 )。结论氯沙坦可降低糖尿病肾病伴高血压患者的尿白蛋白 ,同时降低血压 ,但不能改变糖尿病高血压患者的血压昼夜节律异常 ,氯沙坦有独立于降压之外的降低糖尿病伴高血压患者的尿白蛋白 ,同时降低血压 ,但不能改变糖尿病高血压患者的血压昼夜节律异常 ,对不伴有高血压的糖尿病肾病患者能有效降低尿蛋白 ,而不降低血压。
Objective To observe the effect of losartan on reducing urinary albumin excretion rate and antihypertensive efficacy in patients with diabetic nephropathy complicated with hypertension. Methods Sixty patients with early diabetic nephropathy, including 30 with hypertension, 30 with no hypertension, unchanged the treatment of original diabetes. After the washout period (all vasodilators were discontinued for 2 weeks), losartan The changes of ambulatory blood pressure, urinary albumin excretion rate (UAER), serum creatinine (Cr) and blood urea nitrogen (BUN) were observed after 24 hours. Results UAER was significantly decreased at 24 hours after treatment (P <0.05), while blood pressure was significantly lower at 24 hours (P <0.05) in patients with hypertension and no significant difference between day and night in blood pressure (P> 0 .0 5); no drop in blood pressure in patients with diabetic nephropathy without hypertension was not significant. There was no correlation between the decline of UAER and blood pressure in 24 hours (P> 0.05). Conclusion Losartan can reduce urinary albumin and reduce blood pressure in patients with diabetic nephropathy and hypertension, but can not change the abnormal circadian rhythm of blood pressure in patients with diabetic hypertension. Losartan has the effect of reducing diabetes mellitus with hypertension Patients with urinary albumin, while reducing blood pressure, but can not change the blood pressure in patients with diabetes mellitus abnormal circadian rhythm, without hypertension in patients with diabetic nephropathy can effectively reduce urinary protein, without lowering blood pressure.