摘要
目的探讨氯沙坦和氟伐他汀联合治疗早期糖尿病肾病（DN）的疗效及其机制。方法40例早期DN患者随机分为4组，每组各10例：糖尿病对照组、氯沙坦治疗组、氟伐他汀治疗组、氯沙坦＋氟伐他汀治疗组；另选10例非糖尿病者为正常对照组。糖尿病对照组给予控制血糖等治疗至正常范围，各治疗组在常规治疗的基础上每日分别加服氯沙坦50mg、氟伐代汀40mg和两药联合应用，观察疗程2个月。比较各组尿白蛋白排泄率（UAER）、尿白蛋白（Alb）、血肌酐（SCr）、肌酐清除率（Ccr）、血压、血脂和尿细胞转化生长因子β1（TGF-β1）、尿单核细胞趋化蛋白（MCP-1）等指标的变化。结果各治疗组与糖尿病对照组比较UAER、Alb、尿TGF-β1、MCP-1明显下降（P〈0．05，P〈0．01）；两药联用治疗组上述指标更明显；血脂、血压比较各组无统计学差异（P〉0．05）。结论早期DN患者尿中TGF-β1、MCP-1增加，氯沙坦、氟伐代汀因降低TGF-β1、MCP-1等而减轻微量白蛋白尿及改善肾功能，该作用不依赖于降血压、降血脂效应，两药联用效果更好。
Objective To observe the effects and mechanism of combined use of Losartan and Fluvastatin in the treatment of early diabetic nephropathy. Method Forty patients with early diabetic nephropathy were randomly divided into four groups （ten patients in each group） after controlling the levels of blood glucose： diabetic control group; losartan group with losartan treatment （50mg/d） ;Fluvastatin group with Fluvastatin treatment （40mg/d） and Losartan plus Fluvastatin group receiced losartan（50mg/d） and Fluvastatin （40mg/d） treatment. In addition, ten healthy patieats were choosed as normal control. After the eight-week medication, the patients underwent examinations for changes of blood pressure （BP）, urine albumin （Alb）, Urinary albumin excretion rate （UAER）, TGF-β1. MCP-1 in urine, creatinine clearance rate（Ccr）, serum creatinine （SCr）, the levels of blood glucose and lipids. Results Use alone or combined use of Losartan and Fluvastatin significantly lowered Ccr, UAER, Alb, TGF-β1 .MCP-1 in urine, and combined use of the two drugs produced the most obvious reduction of these parameters. However, there was no obvious change in the blood pressure blood lipids fat after treatment. Conclusions Urinary TGF-β1 .MCP-1 increse in early diabetic nephropathy. Increased, use alone of Losartan and Fluvastatin may decrease urinary UAER, Alb, Ccr respectively through neduction of TGF-β1 and MCP-1 , and combined use of Losartan and Fluvastatin have a better effect in treating early diabetic nephropathy.
出处
《临床肾脏病杂志》
2005年第5期207-209,共3页
Journal Of Clinical Nephrology
