目的 观察阿托伐他汀钙联合厄贝沙坦治疗早期糖尿病肾病(diabetic nephropathy,DN)的临床疗效。方法 75例符合早期糖尿病肾病诊断标准的患者随机分为三组:对照组、治疗A 组、治疗B组,每组各25例。对照组予以糖尿病常规治疗,在常规治疗基础上治疗A组加厄贝沙坦片;治疗B组加厄贝沙坦片及阿托伐他汀钙,疗程3个月。比较各组治疗前后总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG) 及餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA₁c)、血肌酐(Scr)、尿微量白蛋白(U-mAlb) 、尿β₂微球蛋白(U-β₂MG)等。结果 治疗3个月后,各组FPG、2 hPG、HbA₁c等指标比较,差异无统计学意义。治疗A组、治疗B组U-mAlb、U-β₂MG、Scr、TC、TG较治疗前下降,HDL-C升高,差异有统计学意义(P＜0.05);各组治疗后比较,治疗B组U-mAlb、U-β₂MG、Scr、TC、TG较对照组、治疗A组下降,HDL-C升高,差异有统计学意义(P＜0.05)。结论 早期糖尿病肾病采用厄贝沙坦联合阿托伐他汀钙治疗,能明显减少U-mAlb、U-β₂MG,保护肾脏、减缓糖尿病肾病进程,同时对脂代谢紊乱也起到了明显抑制作用。

Objective To study the clinical effect of combined use of atorvastatin combined with irbesartan in the treatment of early diabetic nephropathy. Methods Fighty patients with early diabetic nephropathy who met the diagnostic criteria were randomly divided into three groups:control group(n=25),treatment group A (n=25), treatment group B (n=25). All patients received daily diabetes routine treatment, treatment group A received irbesartan 150 mg qd, treatment group B received atorvastatin 20 mg qd, treatment group C received both irbesartan (150 mg qd) and atorvastatin(20 mg qd). The study courses were three months for all groups. TC, TG, HDL-C, FPG, 2 hPG, HbA₁c, serum creatinine (Scr), urinary albumin (U-mAlb), urinary β₂ microglobulin (β₂-MG) were tested before and after the treatments. Results The FPG, 2 hPG, HbA₁c were significantly lower after the treatment in all groups(P<0.05), and there was no statistical difference between groups. U-mAlb, U-β₂MG, Scr in groups A and B were significantly lower than those before treatment,and there were statistically significant differences between before and after treatment (P<0.05). TC, TG, HDL-C in the contral group were not significantlg different before and after treatment (P>0.05). TC, TG in groups A and B were significantly lower than those before treatment,and HDL-C increased, with significant difference (P<0.05) . Conclusions Atorvastatin combined with irbesartan can effectively mitigate or reverse the early diabetic nephropathy patients with glomerular and renal tubular injury; the mechanism may be related to its combination of intensive lipid-lowering and strengthening the inhibition of RASS system.