替米沙坦联合羟苯磺酸钙治疗老年糖尿病肾病合并高血压的临床效果

摘要

目的：分析替米沙坦联合羟苯磺酸钙治疗老年2型糖尿病肾病合并高血压的临床效果。方法应用随机数字表法将营口市中心医院收治的老年2型糖尿病肾病合并高血压患者分为单用替米沙坦80 mg/d治疗的对照组和采取替米沙坦80 mg/d联合羟苯磺酸钙1 g/d治疗的联合组，每组各40例。经过12周的治疗，比较两组患者治疗前后收缩压(SBP)、舒张压(DBP)、24 h尿蛋白(24Upro)、24 h尿白蛋白排泄率(UAER)和血清肌酐(SCr)以及血液流变学和炎症因子白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)的变化。结果两组患者治疗后血压(SBP、DBP)和主要肾功能指标(24Upro、UAER、SCr)均较治疗前显著降低，差异均有统计学意义(P<0.05)；联合组治疗后24Upro[(0.75±0.24)g/24 h]和UAER[(94.02±21.05)mg/24 h]水平显著低于对照组[(0.87±0.20)g/24 h、(127.10±19.03)mg/24 h]，差异有统计学意义(P<0.05)。联合组治疗后血浆黏度[(1.37±0.24)mPa·s]和全血还原黏度[(0.11±0.01)mPa·s]与对照组治疗后血浆黏度[(3.19±0.47)mPa·s]和全血还原黏度[(0.15±0.03)mPa·s]比较差异有统计学意义(P<0.05)。此外，联合组治疗后IL-6[(94.60±11.80)pg/mL]水平显著低于对照组治疗后[(120.30±16.50)pg/mL](P<0.05)。结论替米沙坦联合羟苯磺酸钙治疗2型糖尿病肾病合并高血压效果显著，可有效降低患者尿蛋白含量，改善微循环、抗炎，发挥良好的肾脏保护作用，具有较好的临床推广应用价值。%Objective To investigate the clinical effect of Telmisartan combined with Calcium Dobesilate in the treat-ment of elderly patients with type 2 diabetic nephropathy (T2DN) and hypertension. Methods Patients with T2DN and hy-pertension were randomly divided into control group treated with single Telmisartan 80 mg/d and combined group treated with Telmisartan 80 mg/d combined with Calcium Dobesilate 1 g/d, with 40 cases in each group. After treatment for 12 weeks, the changes of diastolic blood pressure (DBP), systolic blood pressure (SBP), 24-hour urinary protein (24Upro), 24-hour urinary albumin excretion rate (UAER) and serum creatinine (SCr), and the factors of hemorheology, inflammatory cy-tokines interleukin -6 (IL-6), and tumor necrosis factor α (TNF-α) were determined and compared between the two groups. Results After treatment, the levels of blood pressure (SBP, DBP) and the main indexes of renal function (24Upro, UAER, SCr) in the two groups were all decreased compared with those before treatment, the differences were all statistically significant (P< 0.05). The levels of 24Upro [(0.75±0.24) g/24h] and UAER [(94.02±21.05) mg/24 h] af-ter treatment in combined group were lower than those of control group [(0.87±0.20) g/24 h, (127.10±19.03) mg/24 h], the differences were statistically significant (P<0.05). After treatment, the differences of blood plasma viscosity [(1.37±0.24) mPa·s] and whole blood reduced viscosity [(0.11±0.01) mPa·s] in combined group and blood plasma viscosity [(3.19±0.47) mPa·s] and whole blood reduced viscosity [(0.15±0.03) mPa·s] in control group were statistically signifi-cant (P<0.05). In addition, the level of IL-6 after treatment in combined group [(94.60±11.80) pg/mL] was significantly lower than that of control group [(120.30±16.50) pg/mL] (P< 0.05). Conclusion Telmisartan combined with Calcium Dobesilate in the treatment of patients with T2DN and hypertension can significantly decrease the urinary protein level, improve microcirculation, and it has an anti-inflammatory effects, plays a good renal protective effect, which has a good value for clinical application.