绞股蓝总甙与缬沙坦治疗早期糖尿病肾病的对比研究

Comparision of the Renoprotective Effect of Gypenosides and Valsartan in Patients with Early Period of Diabetic Nephropathy

目的:比较绞股蓝总甙与缬沙坦对糖尿病肾病患者血脂、蛋白尿、肾功能的治疗效果。方法:86例早期糖尿病肾病患者随机分为绞股蓝总甙治疗组32例,缬沙坦治疗组28例,对照组26例。绞股蓝总甙组给予绞股蓝总甙片60mg/次,3次/日;缬沙坦组给予缬沙坦80mg/次,1次/日。所有患者继续使用原降糖、降压药物治疗,对照组不再给予其它治疗。观察疗程24周。分别于第0、4、8、12、24周收集血尿标本,检测治疗前后尿微量白蛋白排泄率(UAER)、甘油三脂(TG)、总胆固醇(Ch)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、血肌酐(SCr)、尿素氮(BUN)、尿酸(UA)和尿转化生长因子β(TGF-β)。结果:治疗4周后,绞股蓝总甙组和缬沙坦组UAER即出现下降趋势,随治疗时间延长持续降低。治疗24周后,绞股蓝总甙组和缬沙坦组UAER、SCr、BUN、UA、尿TGF-β均明显降低,与治疗前相比有明显差异(P<0.01);绞股蓝总甙组血脂明显改善,CH、TG、LDL-C明显下降(P<0.01),HDL-C升高(P<0.01);而缬沙坦组和对照组治疗前后血脂有发展趋势,但无统计学意义(P>0.05)。结论:绞股蓝总甙与缬沙坦在防治早期糖尿病肾病方面,均有降低蛋白尿、改善肾功能的作用,二者治疗效果相近,绞股蓝总甙还具有显著改善患者脂质代谢紊乱的作用。

Objective To investigate the effect of gypenosides and valsartan on micralbuminuria, blood lipid and renal function in patients with early period of Diabetic nephropathy. Methods Eighty -six patients with type 2 diabetes mellitus（ Cr 〈 256mmol/L）were divided into three groups according to the drugs：gypenosides Group： 32 patients with type 2 diabetes mellitus received treatment of gypenosides; Group valsartan： 28 patients with type 2 diabetes mellitus received treatment of valsartan ; Group control ： 26 patients with type 2 diabetes mellitus. All the patients received oral glucose - lowering drugs. Blood pressure could be controlled at 130/80 mmHg combined with CCB and β - blocker in patients with hypertension, the period of followup was 24 weeks. At the end of 0,4,8,12,24 weeks, urine micralbuminuria excretion rate （UAER）, blood lipid, renal function, and the urinary TGF - β were measured. Results Before and after treatment, compared with control group, UAER, SCr,BUN,UA and the urinary TGF - β decreased significantly in patients with intervention of gypenoside and valsartan （P 〈 0.01 ）, CH, TG and LDL- C decreased significantly （P 〈 0.01 ）, HDL -C increased significantly （ P 〈 0.01 ） in the patients with treatment of gypenoside. There were no significant difference in blood lipid in the patients before and after treatment of valsartan （ P 〉 0.05 ）. Conclusion Gypenoside and valsartan could significantly decrease UAER, urinary TGF- β,and improve the renal function. In addition, gypenoside might significantly regulate blood lipid in the patients with Diabetic nephropathy.