Comparison Of Therapeutic Effects Of Calcium Dobesilate And Perindopril In Treatment Of Early Diabetic Nephropathy

Background Diabetic nephropathy is one of the common diabetic micrangium complication diseases, and also the main detal cause of diabetic patients. Diabetic nephropathy has become the important cause which lead to end-stage renal disease, due to the high incidence and the prolong of diabetic patients' lifetime. Most trials proved that angiotensin converting enzyme inhibitors can slow down the development of diabetic nephropathy due to its renal protection which is independent of lowing blood pressure. Calcium dobesilate is a veno-tonic drug which has been widely prescribed in treatment of diabetic retinopathy for more than 30 years. Diabetic nephropathy and diabetic retinopathy has common pathogenesis, so it is speculated that calcium dobesilate may be used on diabetic nephropathy.Objective (1)to compare therapeutic effects of calcium dobesilate and perindopril on patients with early diabetic nephropathy in order to find a new therapeutic approach to diabetic nephropathy. (2)to explore the therapeutic mechanism of calcium dobesilate on diabetic nephropathy. Methods 117 patients with early diabetic nephropathy and blood pressure≤135/85mmHg were divided into three groups. A group (36 cases) was treated merely to control blood glucose; B group(41 cases) was treated with calcium dobesilate 500mg tid; C group(40 cases) was treated with perin- dopril 4mg qd for 12 weeks. Urinary albumin excretion (UAE), blood pressure, plasminogen activator inhibitor-1(PAI-1), hemorheology, endothelin (ET), netric oxide(NO), thromboxane B₂(TXB₂), 6-keto - prostaglandin F1_α(6-keto-PGF_1α), plasma glucose, glycosylated hemoglobin (HbA1c), fasting serum C peptide, lipidemia, hepatic and renal function were examined before and after the treatment.Results (1)After 12 weeks, the levels of UAE decreased significantly in B and C groups (P<0. 05) and there is no difference between them; the levels of UAE didn' t change in A group though the metabolism is stable; there is significant difference between A and the former two groups.(2)The levels of PAI-1, ET, TXB₂, blood viscosity, plasma viscosity and fibrinogen decreased while the levels of NO and 6-keto-PGF_1α increased in B group; the levels of PAI-1 decreased in C group; the above-mentioned indexes had no changes in A group. (3)The levels of FPG, p2hPG, HbA1c, fasting serum C peptide, lipidemia, hepatic and renal function didn' t change in the three groups.Conclusion (1) The therapeutic effect that calcium dobesilate decreases the levels of UAE and PAI-1 in patients with early diabetic nephropathy is similar to that of perindopril; the benefit is positively correlated with the time of taking calcium dobesilate. (2)Calcium dobesilate may postpone the development of diabetic nephropathy through improveming hemorheology, decreasing PAI-1, ET, TXB₂ and increasing NO and 6-keto-PGF_1α.