Momeni Ali, Behradmanesh Mohammad Saeed, Kheiri Soleiman, Karami Horestani Mohammad
Shahrekord University of Medical Sciences, Iran
Shahrekord University of Medical Sciences, Iran.
J Renin Angiotensin Aldosterone Syst. 2015 Mar;16(1):113-8. doi: 10.1177/1470320313481485. Epub 2013 Mar 13.
Inhibitors of the renin-angiotensin aldosterone system (RAAS) are the basic drugs for treatment of diabetic nephropathy, as to some extent is spironolactone. The aim of the study was to evaluate the effect of spironolactone versus spironolactone plus hydrochlorothiazide in decreasing proteinuria in type 2 diabetic mellitus (T2DM) patients.
In a double-blind clinical trial, 60 T2DM patients with nephropathy randomly assigned to three equal groups were enrolled. Spironolactone (50 mg/day) plus placebo, spironolactone (50 mg/day) plus hydrochlorothiazide (25 mg/day), and hydrochlorothiazide (25 mg/day) plus placebo were prescribed, respectively. The duration of treatment was three months for all patients. Urine protein was measured at the beginning and end of the study and analysis of data was performed.
Twenty-six of the patients were male, with a total mean age of 56.8 ± 8.3 years. Mean 24-h urine protein was reduced in patients in groups 1 and 2 compared to the third group (p < 0.001). Serum potassium in the first group showed a significant increase of 0.26 meq/lit with mean 4.64 ± 0.28 meq/lit (p = 0.002), but it did not change in the second and third groups.
Our results showed that spironolactone plus hydrochlorothiazide is an effective and inexpensive modality in the treatment of diabetic nephropathy without increasing serum potassium.
肾素-血管紧张素-醛固酮系统（RAAS）抑制剂是治疗糖尿病肾病的基础药物，螺内酯在一定程度上也属于此类药物。本研究旨在评估螺内酯与螺内酯加氢氯噻嗪在降低2型糖尿病（T2DM）患者蛋白尿方面的效果。
在一项双盲临床试验中，纳入了60例患有肾病的T2DM患者，并将其随机分为三组，每组人数相等。分别给予螺内酯（50毫克/天）加安慰剂、螺内酯（50毫克/天）加氢氯噻嗪（25毫克/天）、氢氯噻嗪（25毫克/天）加安慰剂。所有患者的治疗持续时间均为三个月。在研究开始和结束时测量尿蛋白，并进行数据分析。
患者中有26例为男性，总平均年龄为56.8±8.3岁。与第三组相比，第一组和第二组患者的平均24小时尿蛋白有所降低（p<0.001）。第一组患者的血清钾显著升高0.26毫当量/升，平均为4.64±0.28毫当量/升（p = 0.002），但第二组和第三组患者的血清钾没有变化。
我们的结果表明，螺内酯加氢氯噻嗪是治疗糖尿病肾病的一种有效且廉价的方法，且不会增加血清钾水平。
