苯磺酸氨氯地平联合依那普利治疗糖尿病肾病伴高血压的有效性及安全性研究

摘要

目的：探讨苯磺酸氨氯地平联合依那普利治疗糖尿病肾病伴高血压的有效性及安全性。方法选择2012年8月—2014年10月泸州医学院附属医院收治的糖尿病肾病伴高血压患者118例，按照随机数字表法分为依那普利组（n ＝35）、苯磺酸氨氯地平组（n ＝39）及联合治疗组（n ＝44）。3组患者入组前均停用降压药物2周，常规给予胰岛素、二甲双胍等药物治疗。依那普利组给予依那普利片治疗，苯磺酸氨氯地平组给予苯磺酸氨氯地平片治疗，联合治疗组给予依那普利片联合苯磺酸氨氯地平片治疗，3组患者均治疗4周。观察 3组患者治疗前和治疗4周后血压、血糖、肾功能指标变化及治疗期间不良反应发生情况，血压包括24 h 收缩压（24 h SBP）、24 h 舒张压（24 h DBP）及24 h 平均动脉压（24 h MAP），血糖包括空腹血糖（ FBG）、餐后2 h 血糖（2 h PBG）及糖化血红蛋白（HbA1c ），肾功能指标包括尿素氮（BUN）、血肌酐（Scr）及24 h 尿蛋白定量（24 h UPr）。结果治疗前 3组患者24 h SBP、24 h DBP 及24 h MAP 比较，差异无统计学意义（P ＞0.05）；治疗后联合治疗组患者24 h SBP、DBP 及 MAP 均低于苯磺酸氨氯地平组和依那普利组（P ＜0.05）。3组患者治疗前24 h UPr 和 Scr 及治疗前后 BUN 比较，差异无统计学意义（P ＞0.05）；治疗后联合治疗组患者24 h UPr 和 Scr 低于苯磺酸氨氯地平组和依那普利组（P ＜0.05）。3组患者治疗前后 FBG、2 h PBG 及 HbA1c水平比较，差异均无统计学意义（P ＞0.05）。治疗期间依那普利组患者不良反应发生率为11.4%，苯磺酸氨氯地平组为10.3%，联合治疗组为13.6%，差异无统计学意义（P ＞0.05）。结论苯磺酸氨氯地平联合依那普利治疗糖尿病肾病伴高血压的降压、降血糖及肾脏保护效果优于二者单用，且未增加不良反应。%Objective To investigate effectiveness and safety of amlodipine besylate combined with enalapril on diabetic nephropathy complicated with hypertension. Methods From August 2012 to October 2014 in the Affiliated Hospital of Luzhou Medical College,a total of 118 diabetic nephropathy patients complicated with hypertension were divided into groups A (n = 35 ),B ( n = 39 ) and C ( n = 44 ) according to random number table. Patients of the three groups deactivate antihypertensive drugs before enrolling the study,and were given insulin and metformin to control blood glucose. Patients of A group were given enalapril,patients of B group were given amlodipine besylate,and patients of C group were given amlodipine besylate combined with enalapril,all of the three groups treated for 4 weeks. Blood pressure(including 24 h SBP,24 h DBP, 24 h MAP),glycemic indicators(FBG,2 h PBG,HbA1c ) before and after treatment,incidence of adverse reactions during treatment were compared among the three groups,renal function index ( including BUN, Scr,24 - hour urine protein quantitative). Results No statistically significant differences of 24 h SBP,24 h DBP,24 h MAP,BUN,Scr,24 - hour urine protein quantitative,FBG,2 h PBG or HbA1c was found among the three groups(P > 0. 05);after treatment,24 h SBP, 24 h DBP,24 h MAP,Scr and 24 - hour urine protein quantitative of C group were statistically significantly lower than those of groups A and B,while no statistically significant differences of BUN,FBG,2 h PBG or HbA1c was found among the three groups (P > 0. 05). The incidence of adverse reactions of A group was 11. 4% ,that of B group was 10. 3% ,of C group was 10. 3% , the difference was not statistically significantly different(P > 0. 05). Conclusion Amlodipine besylate combined with enalapril has better antihypertensive effect,hypoglycemic effect and renal protection effect than independent use of amlodipine besylate or enalapril in treating diabetic nephropathy complicated with hypertension,without increasing the incidence of adverse reactions.