张芳. ACEI联合AT1受体阻断剂双重阻断RAS系统治疗老年糖尿病肾病疗效分析[J]. 蚌埠医学院学报, 2020, 45(1): 74-77. DOI: 10.13898/j.cnki.issn.1000-2200.2020.01.019
    引用本文: 张芳. ACEI联合AT1受体阻断剂双重阻断RAS系统治疗老年糖尿病肾病疗效分析[J]. 蚌埠医学院学报, 2020, 45(1): 74-77. DOI: 10.13898/j.cnki.issn.1000-2200.2020.01.019
    ZHANG Fang. Effect of dual blocked RAS system with ACEI combined with ARB in the treatment of elderly diabetic nephropathy[J]. Journal of Bengbu Medical College, 2020, 45(1): 74-77. DOI: 10.13898/j.cnki.issn.1000-2200.2020.01.019
    Citation: ZHANG Fang. Effect of dual blocked RAS system with ACEI combined with ARB in the treatment of elderly diabetic nephropathy[J]. Journal of Bengbu Medical College, 2020, 45(1): 74-77. DOI: 10.13898/j.cnki.issn.1000-2200.2020.01.019

    ACEI联合AT1受体阻断剂双重阻断RAS系统治疗老年糖尿病肾病疗效分析

    Effect of dual blocked RAS system with ACEI combined with ARB in the treatment of elderly diabetic nephropathy

    • 摘要:
      目的探讨血管紧张素转换酶抑制剂(ACEI)联合AT1受体阻断剂(ARB)双重阻断肾素-血管紧张素-醛固酮(RAS)系统对老年糖尿病肾病疗效的影响。
      方法选取141例老年糖尿病肾病病人,随机分为ACEI组、ARB组、联合给药组3组,各47例,ACEI组病人给予贝那普利进行治疗,ARB组给予缬沙坦进行治疗,联合给药组给予贝那普利联合缬沙坦进行治疗。3组均治疗6个月,观察治疗前后3组空腹血糖(FPG)、餐后2 h血糖(PBG2h)、糖化血红蛋白(HbA1c)、收缩压(SBP)、舒张压(DBP)、血清肌酐(SCr)、尿素氮(BUN)、24 h尿微量清蛋白(UAER)含量和不良反应情况。
      结果3组治疗后SBP、DBP均较治疗前显著改善(P < 0.01),FPG和HbA1c仅联合给药组治疗后较前显著改善(P < 0.01),PBG2h则是ARB组和联合给药组较治疗前显著改善(P < 0.01)。3组治疗后除FPG外,PBG2h、HbA1c、SBP、DBP差异均具有统计学意义(P < 0.05~P < 0.01);其中联合给药组治疗后PBG2h、HbA1c、SBP、DBP改善情况均优于ACEI组和ARB组(P < 0.05~P < 0.01)。3组治疗后BUN、SCr、UAER均较治疗前显著改善(P < 0.01);3组治疗后BUN、SCr、UAER差异均具有统计学意义(P < 0.01),其中联合给药组治疗后BUN、SCr、UAER改善情况均优于ACEI组、ARB组(P < 0.01)。ACEI组1例、联合给药组2例病人出现顽固性干咳退出研究,其余均完成研究。ACEI组、ARB组、联合给药组不良反应发生率分别为4.24%、4.24%、6.36%,不良反应发生率差异无统计学意义(P>0.05)。
      结论ACEI联合ARB双重阻断RAS系统治疗老年糖尿病肾病疗效好,可有效控制血糖和血压制,显著改善肾功能指标,优于单用ACEI或ARB,且不良反应发生率低,值得临床推广。

       

      Abstract:
      ObjectiveTo investigate the effects of dual blocked RAS system with angiotensin-converting enzyme inhibitors (ACEI) combined with AT1 receptor blocker (ARB) in the treatment of elderly diabetic nephropathy.
      MethodsOne hundred forty-one elderly patients with diabetic nephropathy were randomly divided into the ACEI group, ARB group and combined group (47 cases in each group).The ACEI group, ARB group and combined group were treated with benazepril, valsartan and benazepril combined with valsartan for 6 months, respectively.The levels of fasting plasma glucose (FPG), 2 h postprandial blood glucose (PBG2h), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (SCr), blood urea nitrogen (BUN) and 24 h urinary microalbumin protein (UAER) before and after treatment, and incidence rate of adverse reactions in three groups were observed.
      ResultsCompared with before treatment, the levels of SBP and DBP in three groups were significantly improved (P < 0.01), the levels of FPG and HbA1c in combined group were significantly improved (P < 0.01), and the levels of PBG2h in ARB group and combined group were significantly improved after treatment (P < 0.01).After treatment, the differences of the levels of PBG2h, HbA1c, SBP and DBP among three groups were statistically significant (P < 0.05 to P < 0.01), and the improvement degrees of PBG2h, HbA1c, SBP and DBP in combined group were better than that in ACEI group and ARB group (P < 0.05 to P < 0.01).Compared with before treatment, the levels of BUN, SCr and UAER in three groups were significantly improved after treatment (P < 0.01).After treatment, the differences of the levels of BUN, SCr and UAER among three groups were statistically significant (P < 0.01), and the improvement degrees of BUN, SCr and UAER in combined group were better than that in ACEI group and ARB group after treatment (P < 0.01).One case in ACEI group and 2 cases in combined group with intractable dry cough quitted the experiment, the other cases completed experiment.The incidence rates of adverse reactions in ACEI group, ARB group and combined group were 4.24%, 4.24% and 6.36%, respectively, and the difference of which was not statistically significant (P>0.05).
      ConclusionsThe dual blocked RAS system with ACEI combined with ARB in treating elderly diabetic nephropathy has good effects and low incidence rate of adverse reactions, which can effectively control blood glucose, blood pressure and significantly improve the renal function, and is better than that of single ACEI or ARB and worthy of promotion.

       

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