Combination therapy with an angiotensin-converting-enzyme inhibitor and an angiotensin II receptor antagonist ameliorates microinflammation and oxidative stress in patients with diabetic nephropathy.
Combination therapy with an angiotensin-converting-enzyme inhibitor and an angiotensin II receptor antagonist ameliorates microinflammation and oxidative stress in patients with diabetic nephropathy.
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DOI：
10.1111/jdi.12004
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发表时间：
2013-03-18
影响因子：
3.2
通讯作者：
Makino H
中科院分区：
文献类型：
--
作者：
Nakamura A;Shikata K;Nakatou T;Kitamura T;Kajitani N;Ogawa D;Makino H
最近的研究表明，血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)联合治疗糖尿病肾病是有效的。然而，关于这种联合治疗的一些争议仍然存在，其肾脏保护作用的机制尚未完全阐明。因此，我们比较了咪达普利(ACEI)和氯沙坦(ARB)联合治疗与单用氯沙坦治疗糖尿病肾病患者的肾脏保护作用。我们还比较了这两种治疗方法的抗炎和抗氧化应激效果。共有32名日本2型糖尿病和肾病患者入选。患者被随机分为两组：氯沙坦100 mg/天(n=16)或氯沙坦50 mg/d加咪达普利5 mg/d(n=16)。观察治疗24周和48周的临床指标、血清超敏C反应蛋白(hs-CRP)、可溶性细胞间黏附分子-1(sICAM-1)、白细胞介素18(IL-18)、单核细胞趋化蛋白-1(MCP-1)、尿液IL-18、MCP-1和8-羟基-2‘-脱氧鸟苷(8-OHdG)浓度。血压在两组之间没有显著差异。治疗后48周，联合治疗组血清hs-CRP、sICAM-1、IL-18水平及尿白蛋白、IL-18、8-OHdG排泄量均显著下降。联合治疗组血清IL-18浓度、尿IL-18和8-OHdG下降百分率明显大于单用组。ACEI和ARB的联合治疗可能通过其抗炎和抗氧化应激作用而有利于糖尿病肾病的治疗。
Recent studies have pointed to the effectiveness of combination therapy with an angiotensin‐converting‐enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB) for diabetic nephropathy. However, some controversy over this combination treatment remains and the mechanisms underlying its renoprotective effects have not been fully clarified. Therefore, we compared the renoprotective effects of imidapril (ACEI) and losartan (ARB) combination therapy with losartan monotherapy in patients with diabetic nephropathy. We also compared the anti‐inflammatory and anti‐oxidative stress effects of these two treatments. A total of 32 Japanese patients with type 2 diabetes and nephropathy were enrolled. Patients were randomized to either 100 mg/day losartan (n = 16) or 50 mg/day losartan plus 5 mg/day imidapril (n = 16). We evaluated clinical parameters, serum concentrations of high‐sensitivity C‐reactive protein (hs‐CRP), soluble intercellular adhesion molecule‐1 (sICAM‐1), interleukin‐18 (IL‐18) and monocyte chemotactic protein‐1 (MCP‐1), and the urinary concentrations of IL‐18, MCP‐1 and 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG) at 24 and 48 weeks after starting treatment. Blood pressure was not significantly different between the two groups. The serum levels of hs‐CRP, sICAM‐1 and IL‐18, as well as urinary excretion of albumin, IL‐18 and 8‐OHdG decreased significantly in the combination therapy group at 48 weeks. The percent decreases in serum IL‐18 concentrations and urinary IL‐18 and 8‐OHdG were significantly greater in the combination therapy group than in the monotherapy group. Combination therapy with an ACEI and an ARB could be beneficial for treating diabetic nephropathy through its anti‐inflammatory and anti‐oxidative stress effects.
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影响因子：
13.2
作者：
Descamps-Latscha, A;Witko-Sarsat, V;Jungers, P
通讯作者：
Jungers, P
影响因子：
8.3
作者：
Ogawa, S;Mori, T;Ito, S
通讯作者：
Ito, S
影响因子：
158.5
作者：
Yusuf, Salim;Teo, Koon K.;Anderson, Craig
通讯作者：
Anderson, Craig
影响因子：
8.3
作者：
Chen, R;Iwai, M;Horiuchi, M
通讯作者：
Horiuchi, M
影响因子：
2.2
作者：
Arnalich, F;Hernanz, A;Montiel, C
通讯作者：
Montiel, C