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目的:观察缬沙坦对2型糖尿病合并大量蛋白尿患者血管内皮功能的保护作用。方法:选取在本院就诊的2型糖尿病合并大量蛋白尿患者80例,随机分为对照组和治疗组,每组各40例,对照组采用常规方法治疗,治疗组在对照组基础上加用缬沙坦口服(80-160mg,每日一次),分别于治疗前检测两组空腹血糖(FBS)、糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血压、心率等基线资料;分析比较治疗12周后两组基质金属蛋白酶9(MMP-9)、24h尿白蛋白排泄率与治疗前差异;并通过超声测定两组肱动脉血管内径和基础血流,计算内皮依赖性血管内径变化率(EDVD)及硝酸甘油介导的血管内径变化率,比较其治疗前后及两组间的差异。结果:治疗前两组基线资料差异无统计学意义(P>0.05)。治疗后两组尿白蛋白排泄率及MMP-9均较治疗前明显降低(P<0.05),治疗组降低更明显(P<0.05);两组EDVD均较治疗前升高(P<0.05),治疗组升高更明显(P<0.05);两组硝酸甘油介导的血管内径变化率变化差异无统计学意义(P>0.05)。结论:缬沙坦能减少2型糖尿病合并大量蛋白尿患者尿白蛋白排泄率,并通过改变基质重构实现对患者血管内皮功能的保护作用。
Objective: To observe the protective effects of valsartan on vascular endothelial function in patients with type 2 diabetes mellitus complicated with proteinuria. Methods: A total of 80 patients with type 2 diabetes mellitus complicated with proteinuria were randomly divided into control group and treatment group, 40 cases in each group. The control group was treated by conventional method. The treatment group was added on the basis of the control group Valsartan was given orally (80-160mg once daily). The levels of fasting blood glucose (FBS), glycosylated hemoglobin (HbA1c), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol HDL-C), blood pressure, heart rate and other baseline data; analysis and comparison of two groups after 12 weeks of treatment of matrix metalloproteinase 9 (MMP-9), 24h urinary albumin excretion rate and pre-treatment differences; and measured by ultrasound brachial artery The changes of endothelium-dependent vascular diameter (EDVD) and nitroglycerin-mediated changes of vascular diameter were compared between the two groups before and after treatment. Results: There was no significant difference in baseline data before treatment (P> 0.05). After treatment, the urinary albumin excretion rate and MMP-9 in both groups were significantly lower than those before treatment (P <0.05), and the levels of MMP-9 in the two groups were significantly lower than those before treatment (P <0.05) (P <0.05). There was no significant difference in the change rate of nitroglycerin between the two groups (P> 0.05). Conclusion: Valsartan can reduce urinary albumin excretion rate in patients with type 2 diabetes mellitus and a large number of proteinuria and protect the vascular endothelial function by changing the matrix remodeling.