Crook Errol D, Preddie Dean C
Wayne State University School of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA.
Ethn Dis. 2002 Fall;12(4):S3-49-52.
Diabetic nephropathy is the number one cause of endstage renal disease in the United States. Blockade of the renin angiotensin system (RAS) is important in the treatment of diabetic nephropathy. With the reports of recently completed trials examining the role of angiotensin receptor blockers (ARBs) in type 2 diabetic nephropathy, the question has arisen as to which agents are best to block the RAS in type 2 diabetes. ACE inhibitors have been to preserve renal function in type 1 diabetics with nephropathy in large, randomized, placebo controlled trials, but such data is lacking in type 2 diabetes. Neverthelesss, ACE inhibitors have been recommended for use in type 2 diabetic nephropathy for some time. In type 2 diabetics, ACE inhibitors may have a role in preventing development of nephropathy, and, importantly, ACE inhibitors have been shown to reduce cardiovascular disease in diabetics with and without nephropathy. In addition, ACE inhibitors have beneficial effects on other diabetic complications such as retinopathy and neuropathy. Until better comparative data between ACE inhibitors and ARBs on nephropathy and cardiovascular outcomes is available, ACE inhibitors should remain an important consideration for treatment of diabetic nephropathy.
糖尿病肾病是美国终末期肾病的首要病因。阻断肾素血管紧张素系统（RAS）在糖尿病肾病的治疗中至关重要。随着近期完成的关于血管紧张素受体阻滞剂（ARB）在2型糖尿病肾病中作用的试验报告的发表，出现了关于在2型糖尿病中哪种药物最适合阻断RAS的问题。在大型随机安慰剂对照试验中，血管紧张素转换酶抑制剂（ACEI）已被证明可在患有肾病的1型糖尿病患者中保护肾功能，但在2型糖尿病中缺乏此类数据。尽管如此，ACEI一段时间以来一直被推荐用于2型糖尿病肾病。在2型糖尿病患者中，ACEI可能在预防肾病发展方面发挥作用，重要的是，ACEI已被证明可降低患有和未患有肾病的糖尿病患者的心血管疾病风险。此外，ACEI对其他糖尿病并发症如视网膜病变和神经病变也有有益作用。在获得关于ACEI和ARB在肾病和心血管结局方面更好的比较数据之前，ACEI仍应是治疗糖尿病肾病的重要考虑药物。
