盐酸特拉唑嗪联合甲钴胺对糖尿病神经源性膀胱患者疗效及其机制的研究

Effect and mechanism of terazosin hydrochloride combined Mecobalamin on diabetic neurogenic bladder

目的探讨盐酸特拉唑嗪联合甲钴胺对糖尿病神经源性膀胱患者的疗效及机制。方法将湖州市中心医院2015年3月—2016年6月收治的90例糖尿病神经源性膀胱患者随机分为2组,每组45例。对照组予α-硫辛酸治疗;治疗组在α-硫辛酸基础上予盐酸特拉唑嗪联合甲钴胺治疗。干预前后采血测定血清氧化应激指标、神经活性指标、早期肾损伤指标,进行尿动力学分析,同时对比临床疗效及不良反应状况。结果治疗组的有效率为88.89%,显著高于对照组的71.11%(P<0.05)。干预后治疗组最大尿流率、最大尿流率时逼尿肌压力、谷胱甘肽(GSH)、超氧化物歧化酶(SOD)、脑源性神经营养因子(BDNF)显著升高,且明显高于对照组(P<0.05)。干预后治疗组膀胱残余尿量、膀胱最大测压容量、血清活性氧(ROS)、丙二醛(MDA)、P物质(SP)、神经肽Y(NPY)、胱抑素C(CysC)、γ-谷氨酰转移酶(γ-GT)显著降低,且明显低于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论盐酸特拉唑嗪联合甲钴胺对糖尿病神经源性膀胱患者疗效确切,降低血清CysC、γ-GT水平,改善氧化应激和神经活性指标,安全性高。

Objective To investigate the effect and mechanism of terazosin hydrochloride combined Mecobalamin on diabetic neurogenic bladder. Methods Ninety cases of diabetic neurogenic bladder in our hospital from March, 2015 to June,2016 were randomly divided into 2 groups, with 45 cases in each group. The patients in the control group received alpha lipoic acid,while the patients in the treatment group received terazosin hydrochloride combined with Mecobalamin based on alpha lipoic acid. Before and after the intervention, serum oxidative stress indices, neural activity index, early renal injury index were tested. Urodynamic were analyzed, and the clinical efficacy and adverse reactions were compared. Results The effective rate of the treatment group was 88.89% ,which was higher than that（71.11% ） of control group （P 〈 0.05 ）. After the intervention, maximum urinary flow rate, detrusor pressure at maximum urinary flow rate, glutathione （GSH）, superoxide dismutase （SOD）, brain derived neurotrophic factor （BDNF） of the treatment group were significantly increased, and significantly higher than those of the control group（P 〈 0.05 ）. After the intervention, bladder residual urine volume, bladder maximum pressure capacity, oxygen activity （ ROS ）, malondialdehyde （ MDA ）, substance P （ SP）, neuropeptide Y （ NPY）, cystatin C （ CysC ） , gamma glutamyl-transferase （γ-GT） of the treatment group were significantly reduced,and significantly lower than those of the control group（ P 〈 0.05 ）. There was no significant difference on the incidence of adverse reaction between the two group （ P 〉 0.05 ）. Conclusion Terazosin hydrochloride combined Mecobalamin have exact efficacy on patients with diabetic neurogenic bladder,it can reduce the CysC and γ-GT level,improve the oxidative stress and neural activity,with high safety.