بررسی تأثیر ترکیب مهار کننده‌های آنزیم مبدل آنژیوتانسین و بلوک کننده‌های گیرنده‌ی آنژیوتانسین بر پیشرفت بیماری کلیوی در بیماران مبتلا به دیابت نوع 2 در مقایسه با تجویز هر یک از این دو دارو به تنهایی

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استاد، گروه نفرولوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی تهران، تهران، ایران

2 دانشیار، گروه نفرلوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی سمنان، سمنان، ایران

3 مربی، گروه تغذیه، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران

4 دستیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی زاهدان، زاهدان، ایران

5 گروه زیست‌شناسی، دانشگاه آزاد اسلامی، واحد فلاورجان، فلاورجان، ایران

6 استاد، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: مهار سیستم رنین- آنژیوتانسین در بیماران مبتلا به نفروپاتی دیابتی منجر به کاهش پروتئینوری و نیز کاهش سرعت پیشرفت نارسایی کلیه می‌گردد. هدف از انجام این مطالعه، بررسی تأثیر توأم مهار کننده‌های آنزیم مبدل آنژیوتانسین (ACEIs یا Angiotensin converting enzyme inhibitors) و بلوک کننده‌های گیرنده‌ی آنژیوتانسین (ARBs یا Angiotensin receptor blockers) بر پیشرفت بیماری کلیوی در بیماران مبتلا به دیابت نوع 2 در مقایسه با تجویز هر یک از این دو دارو به تنهایی بود.روش‌ها: 90 بیمار مبتلا به نفروپاتی دیابتی نوع 2 به صورت تصادفی در سه گروه دریافت کننده‌ی کاپتوپریل، لوزارتان و کاپتوپریل به همراه لوزاتان قرار گرفتند. پروتئینوری در فواصل زمانی قبل از شروع درمان، 2، 6 و 12 ماه و کلیرانس کراتینین در قبل و بعد از درمان در بیماران اندازه‌گیری شد. تحلیل داده‌ها با استفاده از نرم‌افزار SPSS با استفاده از آزمون‌های آماری Repeated measures ANOVA، Fisher's least significant difference (Fisher's LSD) و t Indipendent انجام شد.یافته‌ها: پروتئینوری بیماران در تمامی گروه‌ها با مصرف دارو بهبود یافت و از شدت آن کاسته شد (001/0 > P). این کاهش، در گروه درمان ترکیبی بیشتر از سایر گروه‌ها بود (026/0 = P). کلیرانس کراتینین در هیچ یک از گروه‌ها، تفاوت معنی‌داری نداشت.نتیجه‌گیری: استفاده از دسته‌های دارویی ACEIS و ARBs در کاهش پروتئینوری در نفروپاتی دیابتی در دیابت نوع 2 مؤثر بود، اما درمان ترکیبی از این دو دسته‌ی دارویی به صورت معنی‌داری نتایج بهتری در کاهش پروتئینوری داشت. با این حال، استفاده از این داروها در بهبود کلیرانس کراتینین اثر قابل ملاحظه‌ای نداشت.

کلیدواژه‌ها

عنوان مقاله [English]

The Combined Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on the Progressing of Kidney Disease in Patients with Type 2 Diabetes Compared to Single Administration of Each of These Two Drugs

نویسندگان [English]

  • Hamid Nasri 6
  • Mohammad Reza Tamadon 2
  • Alireza Dashipour 3
  • Hussein Ghazanfari 4
  • Samaneh Khodadadi 5
1 Professor, Department of Nephrology, School of Medicine AND Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
2 Associate Professor, Department of Nephrology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
3 Instructor, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
4 Resident, Department of Internal Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
5 Department of Biology, Falavarjan Branch, Islamic Azad Uiniversity, Falavarjan, Iran
6 Professor, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Inhibition of the renin-angiotensin system in patients with diabetic nephropathy can reduce proteinuria and slow down renal impairment. In this study, we aimed to evaluate the preventive effects of prescribing both angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) for renal disease progression compared with administrating each of these two medications alone in patients with type 2 diabetes.Methods: 90 patients with diabetic nephropathy were randomized into three groups: receiving captopril, losartan, and losartan in combination with captopril. Proteinuria was measured before, 2, 6 and 12 months after intervention, and creatinine clearance was measured before and after intervention. Repeated measures ANOVA, Fisher's least significant difference (Fisher's LSD), and t-test were used for data analysis by SPSS software.Findings: Proteinuria was improved in all groups who received medication (P < 0.001). This reduction in the group who received losartan in combined to captopril was more than other groups (P = 0.026). Creatinine clearance was not significantly different between all groups.Conclusion: Administration of ACEI or ARBs reduced proteinuria in patients suffering from diabetic nephropathy (due to type 2 diabetes) but prescribing both drugs had a significantly better outcome. However, creatinine clearance was not significantly improved in any of the groups.

کلیدواژه‌ها [English]

  • Diabetes Mellitus
  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensin receptor antagonists
  • Proteinuria

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مجله دانشکده پزشکی اصفهان
دوره 34، شماره 369 - شماره پیاپی 369
فروردین و اردیبهشت 1395
صفحه 1-10

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  • تاریخ دریافت: 22 مهر 1394
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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