左旋氨氯地平和依那普利治疗老年2型糖尿病肾病高血压和尿蛋白的临床观察  

Clinical Observation on Nephrotic Hypertension and Albuminuria in Senile NIDDM Patients Treated by Levamlodipine and Enalapril

作　　者：刘丽华[1] 刘勋 等 

机构地区：[1]中南大学湘雅医院，湖南长沙410008 [2]湖南省长沙市芙蓉区医院，湖南长沙410005

出　　处：《医学临床研究》2002年第3期181-183,共3页Journal of Clinical Research

摘　　要：[目的]探讨长效钙离子拮抗剂（左旋氨氯地平）和血管紧张素转换酶（ACE）抑制剂（依那普利）对老年2型糖尿病肾病高血压和尿白蛋白的影响。[方法]将36例糖尿病肾病患者（男23例，女13例，平均年龄63±7岁）随机分为三组；左旋氨氯地平组（12例），依拉普利组（12例）及两药联合治疗组（12例），三组在治疗糖尿病的基础上，分别服用左旋氨氯地平2.5mg，依拉普利5mg，清晨口服，每日一次，如果治疗2周后血压仍未降至正常（>140/90mm-Hg)，则左旋氨氯地平增加至5mg，依拉普利增加至10mg，共用12周。[结果]两药单独治疗均可明显降低糖尿病肾病高血压（P均<0.01)，并可减少24h尿白蛋白排出（P<0.05)。两药联合治疗降低血压和降低尿蛋白的幅度明显优于单独治疗（P<0.01)。[结论]左旋氨氯地平和依拉普利治疗糖尿病肾病所致的高血压均有较好的降低血压和24h尿蛋白的排泄作用。两药联合起协同效应。ObjectivesTo study the effect of a long-acting calcium antagonist (levamlodipine) versus an angiotensin converting enzyme (ACE) inhibitor (enalapril) on nephrotic hypertension and albuminuria in senile NIDDM patients.MethodsThirty-six patients [23 males and 13 females, mean age(63±7) years] with diabetic nephropathy were randomly divided into three groups and treated by double blind method within 12 weeks:①Levamlodipine 2.5 mg was given once daily in the morning (12 patients);② Enalapril 5 mg was administered once daily in the morning (12 patients);③Two drugs in combining use (12 patients). If the blood pressure measured before morning dose of the drugs remained >140/90 mmHg after treatment for 2 weeks ,the dosage should be readjusted to levamlodipine 5 mg/d and enalapril 10mg,/d respectively.ResultsDuring treatment with single drug, the blood pressures in ① and ② groups were significantly lowered(P< 0.01 ),and their urinary albumin excretion rate per 24 h was also decreased (P< 0.05 ). The decreasing extent in blood pressure and albuminuria was more pronounced in group ③(P<0.01).ConclusionIn senile NIDDM patients with hypertensive microalbuminuria, combining use of levamlodipine plus enalapril reveals that the decrease of blood pressure and improvement of urinary albumin excretion are much better than either agent alone. This combination strategy thus should be a more effective tool for obtaining optimal blood pressure control in patients with diabetic nephropathy.

关 键 词：长效钙离子拮抗剂 血管紧张素转换酶抑制剂 左旋氨氯地平 依那普利 治疗 2型糖尿病肾病 高血压 尿蛋白 

分 类 号：R587.1[医药卫生—内分泌] R544.1[医药卫生—内科学]