Diabetes Obes Metab:缬沙坦,贝那普利及其组合对2型糖尿病明显肾病的作用

2020-06-16 MedSci原创 MedSci原创

本研究旨在评估血管紧张素转换酶(ACE)抑制剂和血管紧张素Ⅱ受体阻滞剂(ARB)联合治疗是否比ACE抑制剂或ARB单药治疗对2型糖尿病和显性肾病患者的肾脏保护作用更大。

本研究旨在评估血管紧张素转换酶(ACE)抑制剂和血管紧张素Ⅱ受体阻滞剂(ARB)联合治疗是否比ACE抑制剂或ARB单药治疗对2型糖尿病和显性肾病患者的肾脏保护作用更大。

 

在这项由意大利药物机构赞助的前瞻性、随机、开放、盲点的III期试验中,103名同意治疗的2型糖尿病患者,年龄>40岁,血清肌酐水平159~309μmol/L,斑点晨尿白蛋白-肌酐比值>1000mg/g(或纳入时接受ACE抑制剂或ARB治疗者>500mg/g),按中心分层,随机接受4。 5年的缬沙坦320 mg/d(n = 36)、贝那西普利20 mg/d(n = 34)或两种药物减半剂量(n = 33)治疗。主要终点是终末期肾病(ESRD)。进行了修改后的意向治疗分析。

 

2007年6月至2013年2月期间,在意大利的10个中心和斯洛文尼亚的一个中心进行了招募。共有77名参与者完成研究,26名参与者提前退出。在41(18-54)个月的中位数(四分位数范围)内,12名服用贝那普利(35.3%)和9名服用联合治疗(27.3%)的参与者进展为ESRD,而5名服用缬沙坦(13.9%)。贝那普利(危险比[HR]3.59,95%置信区间[CI]1.25-10.30;P = 0.018)或联合治疗(HR 3.28,95% CI 1.07-10.0;P = 0. 038)和缬沙坦显著,即使在校正年龄、性别和基线血清肌酐、收缩压和24小时蛋白尿后也是如此(HR 5.16,95% CI 1.50-17.75,P = 0.009和HR 4.75,95% CI 1.01-22.39,P = 0.049)。不良事件在各组间分布相似。

 

综上所述,该研究结果表明,在伴有肾病的2型糖尿病患者中,缬沙坦(320 mg/d)比苯扎普利(20 mg/d)或比两种药物减半剂量更安全有效地推迟ESRD。

 

原始出处:

 

Piero Ruggenenti, Matias Trillini, et al., Effects of Valsartan, Benazepril and Their Combination in Overt Nephropathy of Type 2 Diabetes: A Prospective, Randomized, Controlled Trial. Diabetes Obes Metab. 2019 May;21(5):1177-1190. doi: 10.1111/dom.13639.  

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    2021-05-23 guojianrong
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    2020-12-21 一闲
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    2020-06-16 misszhang

    谢谢MedSci提供最新的资讯

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