Effect Of Eplerenone And Spironolactone On Comparison Of Efficacy And Safety Of Diabetic Nephropathy

ObjectiveA large number of studies have shown that spironolactone improvesdiabetic nephropathy glomerulosclerosis, interstitial fibrosis and inhibitschronic inflammation, which may slow the progression of diabetic nephropathy,but the side effects of its inhibition to progesterone and androgen were alsofollowed with interest by more and more people. Eplerenone as new aldosteroneantagonist possess high selectivity, none above-mentioned side effects. Thispaper aims to contrast both efficacy and safety.Methods90patients of diabetic nephropathy were randomly divided into threegroups: group A (spironolactone treatment group)(n=30, age35-58years,duration3-6years), B group (eplerenone treatment group)(n=30,38-60year-old age, disease duration4-7years), group C (control group)(n=30, age36-60years of age, duration of3-7years). The three groups of patients allsupply diabetes education, diet control, according to the blood sugar, bloodpressure, blood lipids give hypoglycemic, antihypertensive and lipid-loweringdrug therapy. Dietary treatment gave diabetic diet, protein intake is1.0g/(kg d). Hypoglycemic therapy select oral hypoglycemic agents or insulin. Strictcontrol of blood pressure, so try to control within the normal range. If bloodpressure control is not ideal and combine antihypertensive drugs having noneeffect on glucose and lipid metabolism. Lipid lowering therapy generally opt forstatins. After the above treatment, group A plus treatment with spironolactone,dose of20mg bid (Hangzhou Minsheng Pharmaceutical Company productionspecifications20mg/tablets), group B plus eplerenone therapy, a dose of50mg qd (Pfizer Limited production specifications25mg/tablets). Between eachgroup, age, disease duration, blood glucose, systolic blood pressure, diastolicblood pressure, cholesterol, and triglycerides were not statistically significant.0,4,8,12weeks before and after treatment, observe urine microalbumin (immuneturbidimetric method),24-hours urinary protein excretion (turbidimetric method,721spectrophotometer determination of24-hour urinary protein excretion),plasma laminin protein (chemiluminescence), type Ⅲ procollagen(chemiluminescence), type Ⅳ collagen (chemiluminescence), tumor necrosisfactor α (chemiluminescence), potassium (ion selective electrode), bloodpressure, progesterone (chemical chemiluminescence), testosterone (chemiluminescence) changes.ResultsA and B group before and after treatment, urine microalbumin,24-hoursurinary protein, plasma laminin, type III procollagen, type IV collagen, tumornecrosis factor α were significantly improved, which have statisticallysignificant; C group, the above index have no marked change before and aftertreatment, no statistically significant; potassium as well as blood pressure haveno significant changes in three groups before and after treatment, no statisticallysignificant; progesterone, testosterone before and after treatment, A has changes,both have statistically significant; groups B and C have no significant changesbefore and after treatment, no statistically significant; There have statisticallysignificant for progesterone and testosterone when comparing A group and Bgroup.Conclusions�'�Spironolactone and eplerenone may reduce renal fibrosis, glomeruloscle-rosis, can inhibit chronic renal inflammation;�'�The effects of eplerenone with regard to progesterone and androgen issmaller than spironolactone, the two have statistical significance;�'�Related index in control group than before treatment was increasedslightly,which may produce aldosterone escape.