尿激酶对糖尿病肾脏病患者血纤溶酶原激活物抑制物1的影响

Clinical effect of urokinase on plasminogen activator inhibitor-1 in patients with diabetic kidney disease

目的观察尿激酶对糖尿病肾脏病（DKD）患者血纤溶酶原激活物抑制物1（PAI-1）的影响及其临床疗效。方法选择在我院住院的DKD患者88例，其中Ⅲ期43例、Ⅳ期45例。将DKDⅢ、Ⅳ期患者分别分为对照组（DKDⅢ-C组、DKDⅣ—C组）和观察组（DKDⅢ-O组、DKDⅣ—O组）。对照组给予常规降糖、保护肾脏及血管紧张素转化酶抑制剂（ACEI）等药物治疗。观察组在常规治疗的基础上给予尿激酶50000U加入100ml生理盐水中静脉滴注，每天1次，共14d。比较各组24h尿白蛋白量、空腹血糖、血肌酐、D-二聚体和血PAI-1水平。结果DKDⅢ—C组和DKDⅣ—C组治疗前、后24h尿白蛋白量、空腹血糖、血肌酐、D-二聚体和血PAI-1均无统计学差异（P〉0．05）。DKDⅢ-O组和DKDⅣ—O组治疗后24h尿白蛋白量和血PAI-1均降低（P〈0．05），而空腹血糖、血肌酐、D二聚体治疗前、后均无统计学差异（P〉0．05）。治疗后，DKDⅢ-O组血PAI-1及24h尿白蛋白下降程度较DKDⅣ—O组明显（P〈0．01）。结论尿激酶可通过降低血PAI-1水平来减少DKD患者尿白蛋白量，对保护肾功能、延缓DKD进展有积极意义，且小剂量应用未增加出血倾向，对DKD是一种安全有效的治疗方法。

Objective To observe the clinical effect of urokinase on plasminogen activator inhib- itor-1 in patients with diabetic kidney disease （DKD）. Methods Eighty-eight DKD inpatients in our hospital were chosen, including 43 cases of DKDⅢ, and 45 cases of DKD IV. The patients with DKDⅢ were divided into control group （DKD Ⅲ-C group） and observation group （DKD Ⅲ-O group）, and those with DKD Ⅳ were also divided into control group （DKD Ⅳ-C group） and observation group （DKD Ⅳ-O group）. The patients in control groups received routine treatments including blood glu- cose-reducing, kidney protection and angiotensin converting enzyme inhibitors （ACEI）, and those in observation groups were given 50 000 U urokinase in 100 ml normal saline, once every day, days in addition to the routine treatments. The amount of 24-h urinary albumin, fasting blood glucose, serum creatinine, D-dimer and blood PAI-1 levels were compared. Results Between DKD Ⅲ-C group and DKD Ⅳ-C group before and after treatments, there was no significant difference in the amount of 24- h urinary albumin, fasting blood glucose, serum creatinine, D dimer and blood PAI-1 levels （P〉0. 05）. In DKD Ⅲ-O group and the DKD Ⅳ-O group after treatments, the amount of 24-h urinary al- bumin and blood PAI-1 levels were significantly lower than those before treatments （P〈0. 05）, but there was no significant difference in fasting blood glucose, serum creatinine and D-dimer before and after treatments （P〉0. 05）. After treatment, blood PAI-1 levels and amount of 24-h urinary albumin were reduced more significantly in DKD Ⅲ-O group than in DKD Ⅳ-O group （P〈0. 01）. Conclusions Urokinase can decrease the blood PAI-1 levels, resulting the decrease in 24-h urinary albumin in DKD patients,which can protect renal function, and delay progress of DKD. Low doses of urokinasedo not increase the bleeding tendency in DKD.