Objective To observe the effect of irbesartan combined with calcium dobesilate on the changes of intrarenal hemodynamic and blood rheology in patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods A total of 142 cases(119 cases in clinical trial)of patients with early T2DM and hypertension(Department of Cardiology,the First Affiliated Hospital of China Medical University,June 3,2015)who had normal renal function were selected and divided into the control group(n=57,of which 50 cases accomplished the trials)and the observation group(n=62,of which 53 cases accomplished the trials)according to random number table method.The control group was given hypotension(irbesartan)+hypoglycemia(metformin+sitagliptin)+improving circulatory(ginaton),and the observation group was given calcium dobesilate on the treatment of the control group.The two groups were treated for 30 days.After the treatment,the changes of fasting plasma glucose(FBG),2-hour postprandial blood glucose(2 hPBG), body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),blood urea nitrogen(BUN),cre-atinine (Cr), glomerular filtration rate (GFR), albumin excrete rate (AER), urinary albumin/creatinine ratio (UACR), blood rheology, and intrarenal hemodynamic (bilateral kidney RI) in bilateral interlobular renal arteries were observed and evaluated using color Doppler sonography.The adverse events during the treatment were recorded.Results After the treatment,the FBG and 2 hPBG in the two groups both significantly lower than those before the treatment(P<0.05), while there was no significant difference between the two groups in BMI(P>0.05);there was no significant difference between the two groups in FBG,2 hPBG and BMI(P>0.05). SBP,DBP,BUN,Cr,GFR,AER,UACR,blood rheology indexes,the intrarenal hemodynamic(bilateral kidney RI)in bilateral interlobular renal arteries in the two groups were significantly lower than those before the treatment(P<0.05),and BUN,Cr,GFR,AER,UACR,blood rheology indexes, the intrarenal hemodynamic(bilateral kidney RI)in bilateral interlobular renal arteries in the observation group were sig-nificantly lower than those in the control group(P<0.05).There was no significant difference between the two groups in SBP and DBP(P>0.05).There was no serious adverse reactions in the two groups during the course of treatment,just with mild malignancy,pruritus and cough,and there was no significant difference between the two groups in the incidence rates (P>0.05). Conclusion Adding calcium dobesilate in the treatment of patients with early T2DM and hypertension who had normal renal function can improve the intrarenal hemodynamics and renal function with less adverse reactions.%目的 观察厄贝沙坦联合羟苯磺酸钙治疗早期2型糖尿病(T2DM)合并高血压患者的肾内血流动力学和血流变学变化情况.方法 收集中国医科大学附属第一医院心内科门诊及病房2015年6月3日收治且肾功能正常的早期2型糖尿病(T2DM)合并高血压患者142例(进入临床实验期119例),采用随机数表法分为对照组(n=57,最后顺利完成50例)与观察组(n=62,最后顺利完成53例).两组患者均给予降压(厄贝沙坦)+降糖(二甲双胍+西格列汀)+改善循环(银杏叶提取物)治疗,观察组在此基础上给予羟苯磺酸钙治疗.连续治疗30 d后观察两组患者的空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、血清尿素氮(BUN)、肌酐(Cr)、肾小球滤过率(GFR)、24 h尿微量白蛋白排泄率(AER)、尿白蛋白/肌酐比值(UACR)、血液流变学指标,并用彩超测定左右肾实质中部的叶间动脉的阻力指数(RI),记录治疗过程中的不良反应.结果 治疗后两组患者的FBG、PBG低于治疗前,且差异均有统计学意义(P<0.05),而BMI与治疗前比较差异无统计学意义(P>0.05);治疗后两组患者的FBG、2 hPBG、BMI比较差异均无统计学意义(P>0.05).治疗后两组患者的SBP、DBP、BUN、Cr、GFR、AER、UACR、血液流变学指标、双肾肾实质中部的叶间动脉的RI均低于治疗前,差异均有统计学意义(P<0.05),且观察组患者的BUN、Cr、GFR、AER、UACR、血液流变学指标、双肾肾实质中部的叶间动脉的RI均低于对照组,差异均有统计学意义(P<0.05),而治疗后两组患者血压(SBP、DBP)比较差异均无统计学意义(P>0.05);治疗过程中两组患者均未发生严重不良反应,仅出现轻度恶性感、皮肤瘙痒感、咳嗽,且两组发生率比较差异无统计学意义(P>0.05).结论 在早期肾功能正常的T2DM合并高血压患者治疗中加用羟苯磺酸钙能很好地改善双肾血流动力学与血流变学,改善肾功能,且不良反应少.
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