前列地尔联合缬沙坦治疗糖尿病肾病的疗效及对肾功能的影响

任薇 包蓓艳 周小帅

[摘要] 目的 研究前列地爾联合缬沙坦治疗糖尿病肾病的疗效及对肾功能的影响。 方法 选取2016年1月～2018年1月在我院住院治疗的90例糖尿病肾病患者作为研究对象，采用随机数字表法随机分为观察组和对照组，每组45例，两组患者均予控制饮食、运动及皮下注射胰岛素等方法将血糖控制在正常水平。对照组予缬沙坦胶囊80 mg，每天1次，连续治疗2周;观察组同时联合前列地尔注射液10 μg 静注，每天1次，连续治疗4周。治疗后取24 h 尿液，采用全自动生化分析仪检测肌酐（creatinine，Cr）、血尿素氮（blood urea nitrogen，BUN）及24 h 尿蛋白，采用放射免疫法测量UAER。同时对比分析两组治疗后的临床总有效率。 结果 对照组治疗后显效27例、有效16例、无效2例，总有效率为77.78%，观察组患者治疗后显效22例、有效13例、无效10例，总有效率为95.56%，观察组临床疗效显著高于对照组。观察组患者治疗后的24 h尿蛋白为（1.37±0.25）g/24 h，UAER为（55.75±13.08）μg/min，SCr为（71.51±12.36）μmol/L，BUN为（6.53±0.37）mmol/L，均显著低于治疗前及对照组，组内及组间比较，差异有统计学意义（P<0.05）。 结论 前列地尔联合缬沙坦治疗糖尿病肾病疗效确切，显著改善肾功能各项指标，且安全性好，值得广泛推广和应用。

[关键词] 糖尿病肾病;前列地尔;缬沙坦;肾功能

[中图分类号] R587.2;R692          [文献标识码] B          [文章编号] 1673-9701（2019）14-0085-04

[Abstract] Objective To study the efficacy of alprostadil combined with valsartan in the treatment of diabetic nephropathy and its effect on renal function. Methods From January 2016 to January 2018， 90 cases of hospitalized patients with diabetic nephropathy in our hospital were selected as the research object， they were randomly divided into observation group and control group by the random number table method， 45 cases in each group. Patients in both groups were given controlled diet， exercise and subcutaneous injection of insulin to control the blood glucose at normal levels. The control group was given valsartan capsule 80 mg， once a day for 2 weeks. The observation group was combined with alprostadil injection 10 μg intravenously once a day for 4 weeks. Urine was collected for 24 hours after treatment， and creatinine （Cr）， blood urea nitrogen （BUN） and 24 h urine protein were detected by automatic biochemical analyzer. UAER was measured by radioimmunoassay. The total clinical effectiveness of the two groups after treatment was compared and analyzed. Results In the control group， the results of 27 cases were significantly effective， of 16 cases were effective， and of 2 cases were ineffective; the total effective rate was 77.78%. In the observation group， the results of 22 cases were significantly effective， of 13 cases were effective， and of 10 cases were ineffective; the total effective rate was 95.56%. The clinical efficacy of the observation group was significantly higher than that of the control group. The 24 h urine protein in the observation group was （1.37±0.25） g/24 h， UAER was （55.75±13.08） μg/min， SCr was（71.51±12.36） μmol/L， and BUN was（6.53±0.37） mmol/L， which were significantly lower than those before treatment and those in the control group， and the differences were statistically significant（P<0.05）. Conclusion The efficacy of alprostadil combined with valsartan in the treatment of diabetic nephropathy is definite， which can significantly improve the renal function indicators， with good safety， thus is worthy of promotion and application.

[Key words] Diabetic nephropathy; Alprostadil; Valsartan; Renal function

糖尿病肾病（diabetic nephropathy，DN）是2型糖尿病远期最为常见的并发症之一，近年来发病率逐年升高。早期糖尿病肾病患者主要表现为肾小球结节样病变和小动脉玻璃样变，微量尿白蛋白持续升高至20～200 μg/min，出现微量白蛋白尿，进一步发展为临床糖尿病肾病期和终末肾衰竭期，DN患者一旦出现临床蛋白尿则病理过程难以逆转[1]。因此，早期治疗具有重大意义，抑制尿蛋白排出、延缓肾病进展是糖尿病肾病临床治疗的关键[2]。……