福辛普利联合氯沙坦治疗2型糖尿病肾病的效果观察及对血管内皮功能的影响  

Effect of Fosinopril Combined with Losartan on Type 2 Diabetic Nephropathy and Its Effect on Vascular Endothelial Function

作　　者：冯莉[1] 杨静[2] 郭年春[1] 高艳山 张丽华 FENG Li;YANG Jing;GUO Nian-chun;GAO Yan-shan;ZHANG Li-hua(Department of Pharmacy,the Eighth Hospital of Shijiazhuang,Shijiazhuang 050000,China;Department of Pharmacy,the Fifth Hospital of Shijiazhuang,Shijiazhuang 050000,China;Department of Endocrinology,Traditional Chinese Medicine Hospital of Dingzhou,Dingzhou,Hebei 073100,China)

机构地区：[1]石家庄市第八医院药剂科,石家庄050000 [2]石家庄市第五医院药剂科,石家庄050000 [3]定州市中医医院内分泌科,河北定州073100

出　　处：《解放军医药杂志》2020年第7期63-67,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省中医药管理局科研计划项目(2019361)。

摘　　要：目的探讨福辛普利联合氯沙坦治疗2型糖尿病肾病(type 2 diabetic nephropathy,T2DN)的效果及对血管内皮功能的影响。方法选取2017年1月-2018年12月收治的T2DN患者110例,根据治疗方法分为观察组和对照组,每组55例。对照组采取常规治疗联合福辛普利治疗,观察组在对照组基础上加用氯沙坦治疗,疗程均为6个月。比较2组治疗后临床疗效,治疗前、治疗6个月后肾功能指标[尿素(BUN)、血肌酐(SCr)、24 h尿白蛋白排泄率(UAER)],血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)],血压[收缩压(SBP)、舒张压(DBP)],血管内皮功能指标[血管紧张素Ⅱ(AngⅡ)、血管内皮生长因子(VEGF)、内皮素-1(ET-1)]水平变化,记录药物不良反应发生情况。结果治疗6个月后,观察组总有效率高于对照组(P<0.01)。治疗6个月后,2组BUN、SCr、24 h UAER、SBP、DBP、AngⅡ、VEGF、ET-1均低于治疗前,且观察组低于对照组(P<0.05)。2组间FPG、2 h PG、HbA1c治疗前后比较差异均无统计学意义(P>0.05)。2组均无严重不良反应发生。结论福辛普利联合氯沙坦治疗可有效提高T2DN治疗效果,更好地控制血压水平,改善患者肾功能和血管内皮功能,且治疗安全性良好。Objective To investigate the effect of Fosinopril combined with losartan on type 2 diabetic nephropathy(T2DN)and its effect on vascular endothelial function.Methods A total of 110 T2DN patients admitted to our hospital from January 2017 to December 2018 were selected as the study subjects,and divided into observation group(n=55)and control group(n=55)according to different treatment methods.The control group was treated with conventional therapy and Fosinopril,and the observation group was supplemented with Losartan on the basis of the control group.The course of treatment was 6 months.The clinical efficacy after treatment,and changes in renal function indexes[blood urea nitrogen(BUN),serum creatinine(SCr)and 24-h urinary albumin excretion rate(UAER)],blood glucose[fasting plasma glucose(FPG),2-h postprandial blood glucose(2 h PG)and glycosylated hemoglobin(HbA1c)],blood pressure[systolic blood pressure(SBP)and diastolic blood pressure(DBP)]and vascular endothelial function indexes[angiotensionⅡ(AngⅡ),vascular endothelial growth factor(VEGF),endothelin-1(ET-1)]before treatment and in 6 months after treatment were compared.The incidence of adverse reactions was recorded.Results At 6 months after treatment,the total effective rate of the observation group was higher than that in the control group(P<0.01).At 6 months after treatment,the BUN,SCr,24 h UAER,SBP,DBP,AngⅡ,VEGF,and ET-1 of the two groups were lower than those before treatment,which were lower in the observation group than in the control group(P<0.05).There was no significant difference in FPG,2 h PG,and HbA1c before and after treatment between the two groups(P>0.05).No serious adverse reactions occurred in both groups.Conclusion Fosinopril combined with Losartan can effectively improve the therapeutic effect of T2DN,better control the blood pressure level,and improve the renal function and vascular endothelial function,with good therapeutic safety.

关 键 词：糖尿病肾病 福辛普利 氯沙坦 24h尿白蛋白排泄 肌酐 血管紧张素Ⅱ 血管内皮生长因子 内皮素-1 

分 类 号：R587.24[医药卫生—内分泌]