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目的探讨应用多重阻断RAAS对非高血压性的早期有或无症状的2型糖尿病患者进行防治糖尿病肾病的必要性、安全性及有效性。方法采用随机多组对照方法,研究应用小剂量ACEI和/或ARB联合醛固酮拮抗剂,单一或多重阻断机体肾素-血管紧张素-醛固酮系统(RAAS),病例定期检测随访12个月以上,观察对不伴有高血压的早期有/无症状的2型糖尿病患者的糖尿病肾病的发生发展的影响,并进行安全性评价。结果多重阻断组糖尿病患者的蛋白尿定性的阳性率比空白对照组为低(P<0.05);单阻断组糖尿病患者的24h蛋白尿定量比空白对照组减少(P<0.05),多重阻断组糖尿病患者的24h蛋白尿定量比空白对照组明显减少(P<0.01)。结论联合2种或以上RAAS阻断剂对延缓不伴有高血压的早期有/无症状的2型糖尿病患者的蛋白尿的发生及减少糖尿病肾病患者的蛋白尿有重要意义;而且小剂量联合2种或以上RAAS阻断剂防治2型糖尿病患者的蛋白尿的发生及减少糖尿病肾病患者蛋白尿的防治方法是安全有效的。
Objective To investigate the necessity, safety and efficacy of multiple blockade of RAAS in preventing and treating diabetic nephropathy in non-hypertensive patients with type 2 diabetes. Methods Randomized multi-group comparison study was conducted to investigate whether single or multiple blockade of the renin-angiotensin-aldosterone system (RAAS) with small doses of ACEI and / or ARB combined with aldosterone antagonists was performed. The patients were followed up for more than 12 months regularly, To observe the development of diabetic nephropathy in patients with type 2 diabetes mellitus who had early / no symptoms of hypertension and evaluate their safety. Results The positive rate of proteinuria in patients with multiple blockade was lower than that in the blank control group (P <0.05). In the single block group, the proteinuria in 24h was lower than that in the blank control group (P <0.05) The 24 h proteinuria in diabetic group was significantly lower than that in the blank control group (P <0.01). Conclusions Combination of two or more RAAS blockers is of great importance to delay the occurrence of proteinuria and reduce proteinuria in diabetic patients with type 2 diabetes mellitus without early hypertension without hypertension. It is safe and effective to control the occurrence of proteinuria in type 2 diabetic patients with RAAS blockers or above and to reduce the proteinuria in patients with diabetic nephropathy.