ACEI联合ARB治疗老年糖尿病肾病的临床观察被引量：13

Clinical Observation of Treating Diabetes Nephropathy in Elderly by ACEI Combined With ARB

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摘要目的:观察比较血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体拮抗剂(ARB)联合应用与单用ACEI或ARB治疗老年糖尿病肾病的疗效。方法:将确诊为糖尿病肾病(DN)老年患者60名随机分为ACEI组19例、ARB组18例、ACEI+ARB联合用药组23例。比较观察治疗2个月后3组患者血压、血肌酐、尿白蛋白排泄率(urinary albuminexcretion rate,UAER)、电解质(钾离子)的变化。结果:各治疗组治疗后血压及尿蛋白排泄率均下降(P<0.05),但联合用药组疗效明显高于ACEI组和ARB组(P<0.05)。结论:对老年糖尿病患者,与单用ACEI或ARB比较,ACEI与ARB联合治疗糖尿病肾病可提高降压效果并明显降低蛋白尿,且副作用小,故联合ACEI及ARB是安全有效治疗方法。 Objective：To compare with curative effects between combining ARB and ACEI and single ACEI or ARB on type -2 diabetes renal proteinuria in elderly. Methods：patients were ramdomly divided into A or B or C groups. The patients in group A were treated with ACEI, The patients in group B were treated with ARB, The patients in group C were treated with ACEI and ARB. 2 months later UAER, blood pressure, serum creatinine , electrolyte （ K ^＋） were observed before and after treatment. Results ： after 2 months treatment, The UAER and blood pressure were lowered in three groups than before treatment , especially in group C. Conclusion：The combination of ACEI with ARB has better renal protective effects on elder DN patients than ACEI or ARB alone, can decrease obviously 24 hour proteinuria levels.

作者沈慧姜红刘正荣

机构地区成都市第七人民医院

出处《现代临床医学》 2009年第5期337-338,共2页 Journal of Modern Clinical Medicine

关键词 ACEI ARB 老年糖尿病肾病 angiotensin converting enzyme inhibitors angiotensin receptor blocker elderly diabetic nephropathy

分类号 R587.2 [医药卫生—内分泌]

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1Kunz R, Frienrich C, Wolbers M, et al. Meta - analysis: effect of monotherapy and combination therapy with inhibitors of the rennin - nagiotensin system on proteinuria in renal disease[ J]. Ann Intern Med, 2008,148 ( 1 ) :30 - 48.
2Burns KD. Angiotensin 1I and its receptors in the diabetic kidney [ J]. Am J Kidney Dis, 2000, 36(3 ) : 449 -467.
3Touyz RM. Molecular and cellular mechanisms in vascular injury in hypertension :role of angiotensin Ⅱ [ J ]. Curr Opin Nephrol Hypertens, 2005, 14(2) :125 -131.
4Lo M, Liu K, Lanlelmep, et al. Subtype 2 of angiotensin 1I receptors Controls presswte natriuresis in rats [ J ]. J Clin Inv, 1995,95 (3) :1394 - 1397.
5Klahr S, Mornssey J. Angiotensin Ⅱ and gene expression in the kidney [J]. Am J kidney Dis, 1998, 31(1) :171 -176.
6顾勇,赖凌云.肾素-血管紧张素系统在糖尿病肾病研究中的新进展[J].中华肾脏病杂志,2004,20(3):221-223. 被引量：44
7Mogensen CE, Neldam S, Tikkntanen I, et al. Randomised controlled trial of dual blockade of renin - angiotensin system in patients with hypentension, microalbuminuria, and non - insulin dependent diabetes : the candesarian and lisinopil microalbuminuria ( CALM ) study [ J ]. BMJ, 2000, 321 (7274) : 1440 - 1444.
8Cao Z, Bonnet F, Candido R, et al. Angiotensin type 2 receptor antagonism confers renal protectin in a rat moder of progressive renal injury [J]. J Am Soc Nephral,2002,13 (7):!773 -1787.

二级参考文献9

1Kelly DJ, Stein-Oakley A, Zhang Y, et al. Fas-induced apoptosis is a feature of progressive diabetic nephropathy in transgenic (mRen-2) 27 rats: attenuation with renin-angiotensin blockade. Nephrology,2004, 9: 7-13.
2Locatelli F, Canaud B, Eckardt KU, et al.The importance of diabetic nephropathy in current nephrological practice. Nephrol Dial Transplant, 2003, 18: 1716-1725.
3Keane WF, Lyle PA. Recent advances in management of type 2 diabetes and nephropathy: lessons from the RENAAL study. Am J Kidney Dis, 2003, 41 Suppl 1: S22-S25.
4American Diabetes Association. Nephropathy in Diabetes. Diabetes Care, 2004, 27Suppl 1: S79-S83.
5Laverman GD, Remuzzi G, Ruggenenti P.ACE inhibition versus angiotensin receptor blockade: which is better for renal and cardiovascular protection? J Am Soc Nephrol, 2004, 15: S64-S70.
6Deferrari G, Ravera M, Berruti V, et al.Optimizing therapy in the diabetic patient with renal disease: antihypertensive treatment. J Am Soc Nephrol, 2004, 15:S6-S11.
7Prisant LM. Diabetes mellitus and hypertension: a mandate for intense treatment according to new guidelines. Am J Ther, 2003, 10: 363-369.
8Berl T. Angiotensin-converting enzyme inhibitors versus AT1 receptor antagonist in cardiovascular and renal protection: the case for AT1 receptor antagonist. J Am Soc Nephrol, 2004, 15:S71-S76.
9Rossing K, Pietraszek L, Jacobsen P, et al. Renoprotective effects of adding angiotensin Ⅱ receptor blocker to maximal recommended doses of ACE inhibitor in diabetic nephropathy. Diabetes Care,2003, 26: 2268-2274.