CAJ | 학술논문

　　目的：旨在探讨厄贝沙坦或氨氯地平是否能独立于其降低体循环血压的作用而减慢2型糖尿病患者的肾病进展。方法：连续入选2009年1月-2011年5月在吴川市人民医院就诊的525例2型糖尿病所致肾病的高血压患者。随机分为接受厄贝沙坦（300 mg/d）、氨氯地平（10 mg/d）或安慰剂治疗组。所有各组目标血压均为≤130/85 mm Hg。比较各组达到主要复合终点的时间及到达次要心血管复合终点的时间。结果：随访时间为平均1.6年。厄贝沙坦治疗与主要复合终点危险下降相关，厄贝沙坦组的危险比安慰剂组低20%（P=0.02），比氨氯地平组低20%（P=0.006）。对于血清肌酐浓度倍增危险，厄贝沙坦组比安慰剂组低33%（P=0.003），比氨氯地平组低37%（P<0.001）。厄贝沙坦治疗使发生终末期肾病的相对危险比其他两组都低20%（两组比较均P=0.07）。这些差异不能用治疗获得的血压差异来解释。厄贝沙坦组血清肌酐浓度增加的速度比安慰剂组慢24%（P=0.008），比氨氯地平组慢21%（P=0.02）。所有原因死亡及心血管复合终点的发生率差异无统计学意义。结论：厄贝沙坦在保护2型糖尿病引起的肾病方面有效，这种保护作用与其引起的血压下降无关。
　　목적：지재탐토액패사탄혹안록지평시부능독립우기강저체순배혈압적작용이감만2형당뇨병환자적신병진전。방법：련속입선2009년1월-2011년5월재오천시인민의원취진적525례2형당뇨병소치신병적고혈압환자。수궤분위접수액패사탄（300 mg/d）、안록지평（10 mg/d）혹안위제치료조。소유각조목표혈압균위≤130/85 mm Hg。비교각조체도주요복합종점적시간급도체차요심혈관복합종점적시간。결과：수방시간위평균1.6년。액패사탄치료여주요복합종점위험하강상관，액패사탄조적위험비안위제조저20%（P=0.02），비안록지평조저20%（P=0.006）。대우혈청기항농도배증위험，액패사탄조비안위제조저33%（P=0.003），비안록지평조저37%（P<0.001）。액패사탄치료사발생종말기신병적상대위험비기타량조도저20%（량조비교균P=0.07）。저사차이불능용치료획득적혈압차이래해석。액패사탄조혈청기항농도증가적속도비안위제조만24%（P=0.008），비안록지평조만21%（P=0.02）。소유원인사망급심혈관복합종점적발생솔차이무통계학의의。결론：액패사탄재보호2형당뇨병인기적신병방면유효，저충보호작용여기인기적혈압하강무관。
Objective:To evaluate whether the angiotensin-Ⅱ-receptor blocker irbesartan slows the progression of nephropathy in patients with type 2 diabetes independently of its capacity to lower the systemic blood pressure. Method:We randomly assigned 525 hypertensive patients with nephropathy due to type 2 diabetes to treatment with irbesartan(300 mg daily),amlodipine(10 mg daily),or placebo. The target blood pressure was 130/85 mm Hg or less in all groups. We compared them with regard to the time to a secondary,cardiovascular composite end point. Result:The mean duration of follow-up was 1.6 years. Treatment with irbesartan was associated with a risk of the primary composite end point that was 20 percent lower than that in the placebo group(P=0.02)and 23 percent lower than that in the amlodipine group(P=0.006). The risk of a doubling of the serum creatinine concentration was 33 percent lower in the irbesartan group than in the placebo group(P=0.003)and 37 percent lower in the irbesartan group than in the amlodipine group(P<0.001). Treatment with irbesartan was associated with a relative risk of end-stage renal disease that was 23 percent lower than that in both other groups(P=0.07 for both comparisons). These differences were not explained by differences in the blood pressures that were achieved. The serum creatinine concentration increased 24 percent more slowly in the irbesartan group than in the placebo group(P=0.008)and 21 percent more slowly than in the amlodipine group(P=0.02). There were no significant differences in the rates of death from any cause or in the cardiovascular composite end point. Conclusion:The angiotensin- Ⅱ -receptor blocker irbesartan is effective in protecting against the progression of nephropathy due to type 2 diabetes. This protection is independent of the reduction in blood pressure it causes.