螺内酯对2型糖尿病肾病患者尿清蛋白的影响  

Impact of Spironolactone on Albuminurea in Patients with Diabetic Nephropathy

作　　者：李世云[1] 李勤[1] 李黎[1] 甘莉[1] 熊萍[1] 饶进[1] 杜春[1] 李龙英[1] 苟晓琴[1] 

机构地区：[1]成都大学附属医院内分泌代谢科,四川省成都市610081

出　　处：《中国全科医学》2011年第33期3784-3786,共3页Chinese General Practice

基　　金：四川省卫生厅科研课题(080090)

摘　　要：目的探讨螺内酯对2型糖尿病肾病患者尿清蛋白的影响。方法选取86例合并Ⅲ期糖尿病肾病的2型糖尿病患者,将其随机分为试验组(44例)和对照组(42例)。对照组采用常规治疗,试验组在常规治疗基础上加用螺内酯20 mg/d,治疗12周。分别观察治疗前后两组患者血压、血糖[空腹血糖(FBG)、餐后2 h血糖(2 hP-BG)]、血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)]、糖化血红蛋白(HbA1c)、尿清蛋白/尿肌酐(ACR)、血电解质(钾、钠)、血肌酐(SCr)等。结果对照组和试验组分别有38例和40例完成研究。两组患者治疗前及治疗后FBG、2 hPBG、收缩压、舒张压、HbA1c、TG、LDL-C、SCr比较,差异均无统计学意义(P>0.05)。对照组患者治疗后ACR与治疗前比较[(110±111)mg/g与(82±68)mg/g],差异无统计学意义(P>0.05);而试验组患者治疗后ACR较治疗前显著降低[(45±47)mg/g与(85±59)mg/g],也显著低于对照组治疗后,差异均有统计学意义(P<0.05)。两组患者治疗后血清TC水平均较治疗前显著降低,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。试验组患者治疗后血钾较治疗前显著升高[(4.10±0.46)mmol/L与(3.82±0.46)mmol/L],血钠水平较对照组显著降低[(139.8±3.1)mmol/L与(141.4±2.4)mmol/L],差异有统计学意义(P<0.05)。结论螺内酯对2型糖尿病肾病具有独立的降低ACR的保肾作用。Objective To explore the impact of spironolactone on albuminuria in type 2 diabetic patients with diabetic nephropathy.Methods Eighty-six cases of diabetes patients with stage III diabetic nephropathy were randomized into the trial group（Group T,n=44） and the control group（Group C,n=42）.Group C were treated with conventional methods,while Group T received additional spironolactone 20 mg daily,both for 12 weeks.Blood pressure,blood glucose[fasting blood glucose（FBG） and 2 h post-prandial blood glucose（2 hPBG）],blood fat[total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholestorol（LDL-C）],glycosated Hb A1c（HbA1c）,urinary ratio of albumin to creatinine（ACR）,electrolytes[serum potassium（SK）,serum natrium（SNa）],serum creatinine（SCr） before and after the intervention were analyzed in both groups.Results A total of 38 cases in Group C and 42 cases in Group T accomplished the study.SBP,DBP,FBG,2 hPBG,TG,LDL-C,HbA1c,and SCr were not significantly different in both groups before and after treatment（P0.05）.ACR before and after treatment were not significantly different in Group C [（110±111）mg/g vs（82±68）mg/g,P0.05]but significantly different in Group T [（45±47）mg/g vs（85±59）mg/g,P0.05].ACR of Group T was significantly lower than that of Group C at the end the trial（P0.05）.Serum TC levels of both two groups decreased after treatment（P0.05）,with no difference noted between the two groups（P0.05）.SK levels in Group T increased significantly at the end of the study[（4.10±0.46）mmol/L vs（3.82±0.46）mmol/L,P0.05].Conclusion Spironolactone decreases ACR and exhibits independent protection effects in type 2 diabetes patients with diabetic nephropathy.

关 键 词：糖尿病 2型 糖尿病肾病 醛固酮拮抗药 螺内酯 尿清蛋白 

分 类 号：R587.24[医药卫生—内分泌]