Durruty P, Tapia J C, Ugarte C, Pérez E, Krause P, Soto N, García de los Ríos M
Unidad de Diabetes y Nutrición, Hospital San Juan de Dios, Santiago de Chile.
Rev Med Chil. 1996 Sep;124(9):1036-44.
Microalbuminuria in diabetic patients is diagnostic of early renal involvement and angiotensin converting enzyme inhibitors reduce albumin excretion in these subjects.
To assess the effects of an angiotensin converting enzyme inhibitor on urinary albumin excretion in non insulin dependent diabetic patients.
Diabetic patients with normal blood pressure were randomly assigned to receive enalapril 10 mg/day or placebo and followed during 18 months. Those with high blood pressure were randomly assigned to receive enalapril or acebutolol in doses necessary to normalize blood pressure and followed during 12 months. Every three months, urinary albumin excretion was measured in a four hour urine sample by radioimmunoassay.
One hundred fifty two patients were recruited for the study and 46 were lost from follow up. In 17 subjects with normal blood pressure initial urinary albumin excretion below cutoff values (30 mg/24 h) and treated with enalapril, this parameter did not change; in 20 treated with placebo, it increased from 5.8 +/- 6.1 to 18.2 +/- 7.5 mg/24 h. In 11 patients with normal pressure and increased initial urinary albumin, this parameter did not change with enalapril and increased in 10 with placebo from 87.3 +/- 75.1 to 253.6 +/- 61.1 mg/24 h. In hypertensive patients with normal urinary albumin excretion, no changes in this parameter were observed in those treated with acebutolol (n = 10) or enalapril (n = 14). In hypertensives with high urinary albumin excretion, it decreased from 119.2 +/- 8.5 to 40.0 +/- 4.7 mg/24 h with enalapril treatment (n = 12), and no change was observed in those treated with acebutolol (n = 11).
Enalapril decreases urinary albumin excretion in non insulin dependent diabetic patients.
糖尿病患者微量白蛋白尿可诊断早期肾脏受累，血管紧张素转换酶抑制剂可减少这些患者的白蛋白排泄。
评估血管紧张素转换酶抑制剂对非胰岛素依赖型糖尿病患者尿白蛋白排泄的影响。
血压正常的糖尿病患者被随机分配接受依那普利10毫克/天或安慰剂治疗，并随访18个月。高血压患者被随机分配接受依那普利或醋丁洛尔治疗，剂量以血压正常化为准，并随访12个月。每三个月，通过放射免疫分析法在4小时尿样中测量尿白蛋白排泄量。
152名患者被纳入研究，46名失访。17名血压正常、初始尿白蛋白排泄低于临界值（30毫克/24小时）且接受依那普利治疗的受试者，该参数未改变；20名接受安慰剂治疗的受试者，其尿白蛋白排泄量从5.8±6.1毫克/24小时增加至18.2±7.5毫克/24小时。11名血压正常且初始尿白蛋白增加的患者，依那普利治疗后该参数未改变，10名接受安慰剂治疗的患者从87.3±75.1毫克/24小时增加至253.6±61.1毫克/24小时。尿白蛋白排泄正常的高血压患者，接受醋丁洛尔（n = 10）或依那普利（n = 14）治疗后该参数无变化。尿白蛋白排泄高的高血压患者，依那普利治疗后从119.2±8.5毫克/24小时降至40.0±4.7毫克/24小时（n = 12），接受醋丁洛尔治疗的患者（n = 11）无变化。
依那普利可降低非胰岛素依赖型糖尿病患者的尿白蛋白排泄量。
