盐酸小檗碱联合厄贝沙坦治疗中老年早期糖尿病肾病的临床观察

Effects of berberine hydrochloride combined with irbesartan on middle-aged and elderly patients with early diabetic nephropathy

目的观察盐酸小檗碱联合厄贝沙坦对中老年早期糖尿病肾病患者的临床疗效并分析可能的机制。方法将入选的92例早期中老年糖尿病肾病患者随机分为两组。对照组48例口服厄贝沙坦治疗,治疗组44例采用盐酸小檗碱联合厄贝沙坦治疗,比较两组治疗前后空腹C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、空腹胰岛素(FIns)、胰岛素抵抗指数(HOMA-IR)、血肌酐(SCr)、尿微量白蛋白排泄率(UAER)水平的变化。结果治疗组治疗后FIns、HOMA-IR、SCr、UAER、CRP、TNF-α指标均较治疗前有不同程度下降,差异均有统计学意义(t分别=11.80、4.43、9.14、8.08、7.53、8.69,P均<0.05);对照组除UARE指标有明显下降,余指标与治疗前比较,差异均无统计学意义(t分别=1.44、1.65、1.59,P均>0.05)。与对照组治疗后比较,各指标下降更明显,差异均有统计学意义(t分别=11.86、2.41、9.28、8.15、5.98、7.14,P均<0.05)。结论盐酸小檗碱联合厄贝沙坦治疗中老年早期糖尿病肾病比单用厄贝沙坦治疗效果好,其机理可能与降低CRP、TNF-α,减轻炎症反应,改善胰岛素抵抗等有关。

Objective To explore the effects of berberine hydrochloride combined with irbesartan on middle-aged and elderly patients with early diabetic nephropathy and it＇s mechanism.Methods A total of 92 elder patients with early diabetic nephropathy were randomly divided into two groups：treatment group and control group.All patients received the same education about diabetes mellitus,diabetic diet,adequate exercise,reduce blood glucose,reduce blood fat,and anti-platelet therapy.Forty-four patients in the control group took orally irbesartan.And those in the treatment group received irbesartan and berberine hydrochloride,4 weeks were one treatment course,and 3 courses were one observation period.The levels of FIns,homa-ir,SCr,UAER,CRP and TNF alpha of the two groups patients were observed.Results After the therapy,FIns,homa-ir,SCr,UAER,CRP and TNF alpha of patients in the treatment group were significantly changed（t =11.80,4.43,9.14,8.08,7.53,8.69,P 0.05）.Compared with those before treatment,except UARE dropped significantly,other indexes were not statistically different in the control group（t = 1.44,1.65,1.59,P 0.05）.Compared with the control group,after treatment,all indexes statistically decreased in the treatment group（t = 11.86,2.41,9.28,8.15,5.98,7.14,P 0.05）.Conclusions It is more effective using berberine hydrochloride and irbesartan on middle-aged and elderly patients with early diabetic nephropathy than using irbesartan alone.Its mechanism may relate with CRP,TNF-α and inflammation response decrease,and insulin resistance improvement.