目的 观察阿法骨化醇联合替米沙坦治疗早期DN疗效. 方法 60例门诊及住院符合入选条件的DN患者随机分为单用阿法骨化醇组(0.25 μg/d)、替米沙坦组(20～40mg/d)、阿法骨化醇(0.25μg/d)联合替米沙坦组(20～40mg/d)进行治疗,每组20例,血压均控制在125/75mmHg以下,疗程12周,治疗前后观察3组患者FBG、HbA1c、血压、24 h UAlb、BUN、肌肝(Cr)、血钙、血钾等水平.结果 3组治疗后24 h UAlb均下降(P＜0.05),联合用药组下降更明显(P＜0.01).其他指标变化差异无统计学意义(P＞0.05).60例患者治疗期间无明显不良反应. 结论 阿法骨化醇和替米沙坦均能降低DN患者的尿蛋白,联合应用疗效更佳.%Objective To investigate the effect of combined therapy with alfacalcidol and telmisartan on the diabetic nephropathy in early stage. Methods The 60 diabetic nephropathy patients in our hospital were enrolled. They were randomly divided into three groups. Group A was treated with alfacalcidol 0. 25 μg per day, group B was treated with telmisartan 20—40 mg per day, and group C was treated with alfacalcidol 0. 25 μg and telmisartan 20—40 mg per day. The blood pressure of all the patients was controlled below 125/75 mmHg. The fasting blood glucose (FBG), HbA1c BP, 24 h urinary protein, urea nitrogen (BUN), serum creatinine (Scr), calcium (Ca2+), and potassium (K+) were measured before and 12 weeks after experiment. Results The 24 h urine protein in all the groups was decreased (P<0. 05) after 12 weeks. Compared with group A and B, the 24 h urine protein in group C was significantly decreased (P<0. 01). There were no significant differences in other indices (P>0. 05). There were no obvious adverse effects during the treatment in all groups. Conclusion Both alfacalcidol and telmisartan can reduce the urine protein excretion in diabetic nephropathy patients. And the combination therapy has additive efficacy.
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