血管紧张素受体阻滞剂联合低分子肝素钙对糖尿病肾病显性蛋白尿疗效观察.docVIP

血管紧张素受体阻滞剂联合低分子肝素钙对糖尿病肾病显性蛋白尿疗效观察摘 要 目的：观察血管紧张素Ⅱ受体阻滞剂联合低分子肝素钙对糖尿病肾病显性蛋白尿的治疗效果。方法：将36例糖尿病肾病显性蛋白尿病人随机分为A、B、C组。A组以降血糖和饮食控制及对症治疗等为常规治疗，加用低分子肝素钙2000AXaIU皮下注射，每日2次；B组常规治疗加用氯沙坦50mg，每日1次，口服；C组常规治疗加用低分子肝素钙2000AXaIU，每日2次皮下注射，同时给予氯沙坦50mg，每日1次口服。观察治疗前后24小时尿蛋白定量，血清白蛋白（ALB）、血肌酐（Scr）、内生肌酐清除率（Ccr）的变化。结果：A组及B组24小时蛋白尿定量均有明显下降，ALB有明显升高，Ccr有轻度下降。C组24小时蛋白尿明显下降，ALB及Ccr均显著升高。结论：血管紧张素Ⅱ受体阻滞剂联合低分子肝素钙对糖尿病肾病显性蛋白尿的治疗有显著疗效，且优于单用血管紧素Ⅱ受体阻滞剂或单用低分子肝素钙。? 关键词 糖尿病肾病 显性蛋白尿 血管紧张素Ⅱ受体阻滞剂 低分子肝素钙? Abstract Objective: To observe clinical effects of the combination of angiotensin Ⅱ receptor blocker and low molecular weight heparin on albuminuria in diabetic nephropathy . Meshods : 36 cases of albuminuria in diabetic nephropathy were randomly divided into three groups. Group A received oral antidiabetic and diet-control treatment ,and in the meantime received low molecular weight heparin (2000U,twice daily);Group B were given losartan (50 mg once a day )together with conventional theraphy ; Group C received low molecular weight heparin (2000U,twice daily)and losartan (50 mg ,once a day )together with conventional theraphy .The 24h urine protein , serum albumn (ALB) , serum creatinine (Scr) and endogenous cleatinine clearance rate (Ccr)of patients in all groups were compaired with the levels before treantment . Result : The 24h urine protein significantly decreased in group A and group B ,the ALB increased ， but the Ccr changed were no statistical significance . The 24h urine protein significantly decreased in group C , the ALB and the Ccr increased more significantly .? Conclusion the application of the combination of angiotensin Ⅱ receptor blocker and low molecular weight heparin on albuminuria in diabetic nephropathy is effective.? 资料与方法? 36例中男20例，女16例；年龄43～69岁；有17例有不同程度的下肢水肿。? 方法：所有的病例都给予常规治疗，即降血糖、饮食控制和对症治疗；血糖的控制全部采用胰岛素皮下注射，36例患者在病情观察期间血糖都能控制在理想的范围之内。随机分为3组，A组12例在常规治疗的基础上加用低分子肝素钙 2000AXaIU皮下注射，每日2次；B组12例在常规治疗的基础上加用氯沙坦50mg，每日1次口服；C组12例在常规治疗的基础上加用低分子肝素钙2000AXaIU，每日2次皮下注射，同时给予氯沙坦50mg，每日1次口服。观察