Department of Metabolism, Endocrinology and Molecular Medicine, and Osaka City University Graduate School of Medicine, Osaka, Japan.
Diabetes Res Clin Pract. 2012 Jul;97(1):91-8. doi: 10.1016/j.diabres.2012.01.024. Epub 2012 Feb 13.
We evaluated the antialbuminuric advantage of cilnidipine, an N/L-type calcium channel blocker (CCB), compared with L-type CCBs in diabetic patients with normoalbuminuria and microalbuminuria. The study was a multicenter, non-randomized crossover trial. Participants were 90 type 2 diabetic patients exhibiting either normo- or microalbuminuria, and undergoing CCB treatment for ≥6 months prior to study entry. The CCB at the time of entry was continued for the first 6 months (Period 1). Treatment was subsequently switched from cilnidipine to an L-type CCB, or vice versa, for the second 6-month observation period (Period 2). During Period 1, the L-type CCB group showed a significant increase of urinary albumin excretion (UAE) over time, while the cilnidipine group showed no significant elevation. During Period 2, switching of the treatment from the L-type CCB to cilnidipine resulted in significant reduction of the UAE, whereas switching from cilnidipine to the L-type CCB resulted in no significant change in the UAE. This study demonstrated that the antialbuminuric effect of Cilnidipine, but not the L-type CCBs, was sustained even in patients treated for a long time. In addition, the antialbuminuric effect can be anticipated after switching from an L-type CCB to cilnidipine, but not vice versa.
我们评估了西尼地平（一种 N/L 型钙通道阻滞剂（CCB））与 L 型 CCB 在具有正常白蛋白尿和微量白蛋白尿的糖尿病患者中的降白蛋白尿优势。该研究是一项多中心、非随机交叉试验。参与者为 90 名 2 型糖尿病患者，他们均表现为正常白蛋白尿或微量白蛋白尿，并且在研究入组前已经接受 CCB 治疗≥6 个月。在第 1 期（Period 1），入组时使用的 CCB 继续治疗 6 个月。随后，在第 2 期（Period 2）的 6 个月观察期内，将治疗方案从西尼地平切换为 L 型 CCB，或反之。在 Period 1 期间，L 型 CCB 组的尿白蛋白排泄量（UAE）随时间呈显著增加，而西尼地平组则没有显著升高。在 Period 2 期间，从 L 型 CCB 切换到西尼地平治疗可显著降低 UAE，而从西尼地平切换到 L 型 CCB 则不会导致 UAE 显著变化。这项研究表明，西尼地平的降白蛋白尿作用（而不是 L 型 CCB）即使在长期治疗的患者中也是持续存在的。此外，从 L 型 CCB 切换到西尼地平后可以预期降白蛋白尿作用，但反之则不然。
