前列地尔联合尿激酶治疗糖尿病肾病尿蛋白的临床观察

Combination therapy of prostaglandin E1 with urokinase for urine protein in patients with diabetic nephropathy

目的:观察短期应用注前列地尔注射液、前列地尔注射液联合小剂量尿激酶对Ⅳ期糖尿病肾病患者尿蛋白的影响。方法:选取我院2005年1月～2009年12月的Ⅳ期糖尿病肾病住院患者548例,均采取强化控制血糖、血压,低蛋白饮食等基础治疗,分为前列地尔治疗组216例、前列地尔联合尿激酶治疗组332例,给予14天短期输液治疗,测定治疗前后24小时尿蛋白。结果:两组患者治疗前年龄、性别组成、糖尿病病程、血糖、血压、血脂、尿蛋白、肾功能等各项指标无显著差异。两组治疗前后各自比较,单独应用注前列地尔注射液、前列地尔注射液联合小剂量尿激酶,均可有效减少糖尿病肾病24小时尿蛋白排泄,但前列地尔注射液联合小剂量尿激酶改善尿蛋白排泄的效果较单独应用注前列地尔更显著(p<0.05),有效率更高(88.2%vs.75.4%,p<0.05);应用小剂量尿激酶未见眼底、皮肤、黏膜出血等不良反应,无凝血功能异常发生。结论:短期静脉应用前列地尔联合小剂量尿激酶治疗Ⅳ期糖尿病肾病,较单独使用前列地尔可更有效减少尿蛋白排泄,不增加眼底出血、皮肤出血、黏膜出血的风险,是一种降低糖尿病肾病尿蛋白水平的安全有效的治疗方法。

Objective： To observe the effects of combined use of PGE1 with urokinase on urine protein in the patients with diabetic nephropathy. Methods： 548 patients with IV phase diabetic nephropathy, who all received a intensive therapy for blood glucose and blood pressure, including low protein diet, were divided into the PGE1 treatment group （216 patients） with PGE1 daily for 14 days, and combination of PGEl with urokinase treatment group （332 patients） with PGE1 and urokinase daily for 14 days. 24 hours urine protein of every patient was determined before and after treatment. Results： Both PGE1 and combination of PGE1 with urokinase decreased 24 hours urine protein compared with that of prior-treatment. Moreover, combination of PGEl with urokinase was more effective and had more effective power than PGE1 single-use. No subhyaloid hemorrhage, dermatorrhagia and tunica mucosa hemorrhage appeared during the course of treatment. Conclusion： Combined administration of PGE1 with urokinase may decrease urine protein more effectively than PGE1 single-use and it is an effective and safe therapy for urine protein in the patients with diabetic nephropathy.