苯那普利联合氯沙坦治疗早期糖尿病肾病的临床研究

目的：研究苯那普利联合氯沙坦对2型糖尿病肾病（diabetic nephropathy，DN）患者肾功能以及血浆脂联素（adiponectin，APN）和高敏C反应蛋白（highsensitivity-C responseprotein，hs-CRP）的影响。方法：选择我院心血管内科住院的2型糖尿病肾病患者42例，均符合早期糖尿病肾病的诊断标准，给予苯那普利10-20mg治疗3个月后，给予苯那普利10mg联合氯沙坦50mg-100mg再治疗3个月，检测和比较治疗前后患者血肌酐（Scr）和24小时尿蛋白定量（24h—UPE）以及血浆hs-CRP和APN水平。结果：苯那普利治疗3个月后，患者的Scr、24h—UPE和hs-CRP水平较治疗前明显降低；血浆APN水平较治疗前明显升高，差异均有统计学意义（P〈0．05）。而苯那普利联合氯沙坦再治疗3个月后，患者的Scr、24h-UPE水平和hs-CRP水平较苯那普利治疗3月时更低，血浆APN水平较苯那普利治疗3个月时更高，差异均有统计学意义（P〈0．05）。结论：苯那普利联合氯沙坦治疗可更好地保护早期糖尿病肾病患者的肾功能，这可能与其提高血浆APN水平和降低CRP水平有关。

Clinical research on the Effects of Benazepril and Losartan in the treatment of Type 2 diabetic nephropathy patients

Objective： To investigate the effect of Benazepril and Losartan on the renal function and serum adiponectin（APN） and high sensitivity C-reactive protein （hs-CRP） levels of patients with type 2 diabetic nephropathy （DN）. Methods： 42 patients with type 2 diabetic nephropathy were enrolled in this study. Diabetic nephropathy was defined as the presence of 24h-UPE, We administered a sub- maximal dose ofbenazepril （20mg/day） for 3 months. After 3months, we administered a dose ofbenazepril （10mg/day） added Losartan 50-100mg/d for 3months. Blood and urine samples were obtained at the baseline, 3 months later, and 6 months later. The plasma concentrations of APN were determined using ELISAs. Blood lipid and 24h-UPE, Scr and hs-CRP were measured routinely. Data were compared before and after the treatment. Results： The scr level, hs-CRP and 24h-UPE were significantly decreased after 3 months＇ treatment compared with those before treatment （P 〈0.05）. The scr level, hs-CRP and 24h-UPE were significantly decreased after 6 months＇ treatment compared with those after 3 months＇ treatment（P〈0.05）. The serum APN level was lower in diabetic patients than that in the healthy control. The serum APN was significantly increased after treatment （P 〈0.05）, which was significantly increased after 6months＇ treatment compared with those after 3 months treatment （P〈0.05）. Conclusion： Combined therapy with ACEI and ARB could better improve the renal function of of patients with type 2 diabetic nephropathy （DN）, the increase of serum APN and decrease of CRP may be involved.