厄贝沙坦对早期糖尿病肾病患者颈动脉内膜中层厚度及临床生化指标影响.docVIP

厄贝沙坦对早期糖尿病肾病患者颈动脉内膜中层厚度及临床生化指标影响 　　【摘要】 目的：观察厄贝沙坦对早期糖尿病肾病（DN）患者临床血生化指标及颈动脉内膜中层厚度（IMT）的影响。方法：将86例血压正常的早期DN患者用随机数字表法分为厄贝沙坦组（E组）和培哚普利组（P组），各43例。两组均给予饮食控制、降低血糖等常规治疗，P组：培哚普利片4 mg/d、1次/d；E组：厄贝沙坦片0.15 g/d、1次/d，疗程为48周。比较两组治疗前后尿清蛋白排泄率（UAER）、血浆Hcy水平及颈动脉IMT等的变化。结果：P组、E组治疗后的UAER、血浆Hcy、SBP、DBP及颈动脉IMT较治疗前均显著降低（P0.05）；Pearson相关分析结果显示IMT值与UAER、Hcy呈正相关（P0.01）。结论：早期DN患者Hcy、UAER与颈动脉IMT之间呈正相关，糖尿病微血管病变与大血管并发症关系密切。厄贝沙坦能降低早期DN患者的SBP、DBP、UAER、Hcy、IMT，对于延缓早期DN患者主要并发症具有现实意义。 　　【关键词】 厄贝沙坦； 糖尿病肾病； 尿清蛋白排泄率； 同型半胱氨酸； 颈动脉内膜中层厚度 　　【Abstract】 Objective：To Observe the effects of irbesartan on carotid intima-media thickness and clinical biochemical indexes of patients with early diabetic nephropathy.Method：86 patients with early DN normotensive were randomly divided into irbesartan group（E group） and perindopril group（P group），43 cases in each group.Both groups were given conventional treatment such as diet control and lower blood sugar.Patients in the P group were given perindopril tablets 4 mg/d，1 time/d，while the E group was given irbesartan tablets 0.15 g/d，1 time/d，the treatment continued for 48 weeks.Urinary albumin excretion rate（UAER），changes in plasma Hcy level and carotid IMT before and after treatment were compared between the two groups.Result：After treatment，the UAER，plasma Hcy level、SBP、DBP and carotid IMT of the two groups were significantly lower than before treatment（P0.05）.Carotid IMT had a positive correlation with UAER and Hcy（P0.01）.Conclusion：UAER and Hcy of patients with early diabetic have a positive correlation with carotid IMT，There is a close relationship between diabetic microvascular lesion and macrovascular complication.Irbesartan can reduce early DN patients’SBP，DBP，UAER，Hcy and IMT，it has a practical significance in delaying early DN patients’ major complications. 　　【Key words】 Irbesartan； Diabetic nephropathy； Urinary albumin excretion rate； Homocysteine； Carotid intima-media thickness 　　糖尿病是动脉粥样硬化的高危因素，其心、脑、肾、眼并发症是糖尿病的主要致死和致残原因。糖尿病肾病（DN）是糖尿病主要微血管并发症之一，其发生和发展与大动脉