一项关于血管紧张素受体阻滞剂和血管紧张素转换酶抑制剂对糖尿病肾病影响的回顾性研究。
A retrospective study of the effects of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in diabetic nephropathy.
作者信息
Pathak Jahnavi V, Dass Ervilla E
机构信息
Department of Pharmacology, Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India.
出版信息
Indian J Pharmacol. 2015 Mar-Apr;47(2):148-52. doi: 10.4103/0253-7613.153420.
OBJECTIVE
Till date, several studies have compared angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in terms of delaying the progression of diabetic nephropathy. But the superiority of one drug class over the other remains unsettled. This study has retrospectively compared the effects of ACE inhibitors and ARBs in diabetic nephropathy. The study aims to compare ACE inhibitors and ARBs in terms of delaying or preventing the progression of diabetic nephropathy, association between blood pressure (B.P) and urinary albumin and also B.P and serum creatinine with ACE inhibitor and ARB, know the percentage of hyperkalemia in patients of diabetic nephropathy receiving ACE inhibitor or ARB.
SETTINGS AND DESIGN
A total of 134 patients diagnosed with diabetic nephropathy during the years 2001-2010 and having a complete follow-up were studied, out of which 99 were on ARB (63 patients of Losartan and 36 of Telmisartan) and 35 on ACE inhibitor (Ramipril).
SUBJECTS AND METHODS
There was at least 1-month of interval between each observation made and also between the date of treatment started and the first reading that is, the observation of the 1(st) month. In total, three readings were taken that is, of the 1(st), 2(nd) and 3(rd) month after the treatment started. Comparison of the 1(st) and 3(rd) month after the treatment started was done. Mean ± standard deviation, Paired t-test, and Chi-square were used for the analysis of the data.
RESULTS
The results reflect that ARBs (Losartan and Telmisartan) when compared to ACE inhibitor (Ramipril) are more effective in terms of delaying the progression of diabetic nephropathy and also in providing renoprotection. Also, ARBs have the property of simultaneously decreasing the systolic B.P and albuminuria when compared to ACE inhibitor (Ramipril).
CONCLUSIONS
Angiotensin receptor blockers are more renoprotective than ACE inhibitors and also provide better cardioprotection.
目的
迄今为止，已有多项研究比较了血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）在延缓糖尿病肾病进展方面的作用。但一类药物相对于另一类药物的优越性仍未确定。本研究回顾性比较了ACE抑制剂和ARB在糖尿病肾病中的作用。该研究旨在比较ACE抑制剂和ARB在延缓或预防糖尿病肾病进展方面的作用、血压（B.P）与尿白蛋白之间的关联以及血压与使用ACE抑制剂和ARB时血清肌酐之间的关联，了解接受ACE抑制剂或ARB治疗的糖尿病肾病患者中高钾血症的发生率。
设置与设计
共研究了2001年至2010年期间诊断为糖尿病肾病且有完整随访记录的134例患者，其中99例使用ARB（63例使用氯沙坦，36例使用替米沙坦），35例使用ACE抑制剂（雷米普利）。
研究对象与方法
每次观察之间以及治疗开始日期与首次读数（即第1个月的观察）之间至少间隔1个月。总共进行了三次读数，即在治疗开始后的第1、2和3个月。对治疗开始后第1个月和第3个月的数据进行了比较。采用均值±标准差、配对t检验和卡方检验对数据进行分析。
结果
结果表明，与ACE抑制剂（雷米普利）相比，ARB（氯沙坦和替米沙坦）在延缓糖尿病肾病进展以及提供肾脏保护方面更有效。此外，与ACE抑制剂（雷米普利）相比，ARB具有同时降低收缩压和蛋白尿的特性。
结论
血管紧张素受体阻滞剂比ACE抑制剂具有更强的肾脏保护作用，并且能提供更好的心脏保护作用。
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