洛沙坦治疗早期糖尿病肾病的研究  

On the treatment of early diabetic nephropathy with Losartan

作　　者：施亚雄[1] 郑善德[1] 

机构地区：[1]福建医科大学附属二院内分泌科,泉州362000

出　　处：《中华内分泌代谢杂志》2000年第4期235-238,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的　观察血管紧张素Ⅱ 1型受体拮抗剂 (AT1Ra)洛沙坦 (Losartan)对伴微量白蛋白尿的早期糖尿病肾病的治疗作用。方法　 80例 2型糖尿病患者 ,2 4小时尿白蛋白排泄率 (2 4hUAER)2 0～ 2 0 0 μg/min ,伴或不伴高血压 ,维持原DM治疗不变 ,分组比较应用洛沙坦 (5 0mg/d)或依那普利(2 0mg/d)治疗 12周前后平均动脉压 (MAP)、2 4hUAER、HbA1c、内生肌酐清除率 (Ccr)、尿酸 (UA)等指标的变化。结果　对照组均无明显变化 ;血压正常的洛沙坦治疗组和依那普利治疗组 2 4hUAER分别由 48(34～ 118)降至 38(2 1～ 89) μg/min(P <0 .0 5 )和由 5 2 (32～ 12 2 )降至 41(2 3～ 90 ) μg/min(P<0 .0 5 )。伴高血压的洛沙坦治疗组 2 4hUAER由 6 2 (38～ 12 3)降至 46 (2 9～ 88) μg/min(P <0 .0 5 ) ;伴高血压的依那普利治疗组 2 4hUAER由 6 8(39～ 130 )降至 5 0 (2 8～ 96 ) μg/min(P <0 .0 5 ) ,二者疗效相似 ,且均与血压变化不相关。结论　AT1Ra洛沙坦可以降低早期糖尿病肾病的蛋白尿 ,其肾脏保护作用除了与降血压有关 ,还有不依赖降压效应的其他机制。Objective To observe the effect of angiotensin Ⅱ 1 type receptor antagonists (AT 1Ra) Losartan on the early diabetic nephropathy with microalbuminuria. Methods 80 cases of type 2 diabetes mellitus (DM) 〔24h urine albumine excretion rate (UAER) 20～200 μg/min〕, with or without hypertension, were selected. The changes of mean arterial pressure (MAP), 24h UAER, HbA 1c , creatinine clearance (Ccr), uratic acid (UA) etc. were compared before and after administration of Losartan (50 mg/d) or Enalapril (20 mg/d) for 12 weeks without changing the previous management of DM. Results No change of above indices was observed in the control group. In the patients with normal blood pressure, 24h UAER decreased from 48(34～118) to 38(21～89)μg/min (P<0.05) in Losartan group and from 52(32～122) to 41(23～90)μg/min (P<0.05) in Enalapril group. In the patients with hypertension, 24h UAER decreased from 62(38～123) to 46(29～88)μg/min (P<0.05) in Losartan group and from 68(39～130) to 50(28～96)μg/min (P<0.05) in Enalapril group. These therapeutic effects were similar and not related to the change of blood pressure. Conclusion AT 1Ra Losartan can reduce the albuminuria of early diabetic nephropathy. The effect of renoprotection is not solely dependent on the lowering blood pressure levels, other mechanism may be involved.

关 键 词：糖尿病肾病 洛沙坦 药物疗法 AT1RA 

分 类 号：R587.2[医药卫生—内分泌] R692.05[医药卫生—内科学]