前列地尔序贯疗法对临床蛋白尿期糖尿病肾病的疗效观察

Effect of alprostadil in sequential therapy of clinical stage diabetic nephropathy

目的观察前列地尔序贯疗法对于临床期糖尿病肾病(DN)的疗效及安全性。方法 90例临床期DN患者经4周常规治疗导入期后随机分为3组:对照组(n=30,常规治疗4周),前列地尔组(n=30,常规治疗+前列地尔注射液2周,继续常规治疗2周),序贯治疗组(n=30,常规治疗+前列地尔注射液2周,常规治疗+贝前列素钠片2周)。比较在导入期后的0周、2周、4周24小时尿微量白蛋白(UMA)、总蛋白(UTP)、血脂及血流变的变化。结果①前列地尔组和序贯治疗组UMA和UTP水平在治疗2周和4周后均较治疗前明显下降(P<0.05),经4周治疗后,序贯治疗组的UMA下降14.0%,UTP下降56.6%。治疗后与对照组和前列地尔组相比,序贯治疗组UMA和UTP下降更明显(P<0.05)。②治疗4周后,前列地尔组和序贯治疗组甘油三酯(TG)、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)较治疗前下降(P<0.05),高密度脂蛋白胆固醇(HDL-C)较前升高(P<0.05);与对照组和前列地尔组相比,序贯治疗组改善上述指标更加明显(P<0.05)。③与对照组比较,序贯治疗组和前列地尔组在治疗2周和4周后的血浆黏度、血沉、红细胞刚性指数以及血浆纤维蛋白原均有所下降(P<0.05),红细胞变性指数有所上升(P<0.05)。而序贯治疗组与前列地尔组相比较上述指标上升和下降的水平更加明显(P<0.05)。结论前列地尔序贯疗法可能通过改善临床期DN患者脂代谢紊乱及血液流变学降低尿蛋白,且具有较好的安全性。

Objective To observe the therapeutic effect and safety of sequential therapy of alprostadil in clinical stage of type 2 diabetic nephropathy. Methods After 4 weeks of lead-in period with conventional therapy, 90 type 2 diabetes meUitus（T2DM） patients with clinical stage nephropathy were randomly divided into three groups, control group（conventional therapy 4 weeks, n = 30）, alprostadil group（conventional therapy plus alprostadil injection 2 weeks and conventional therapy 2 weeks, n = 30） and sequential therapy group（conventional therapy plus alprostadil injection 2 weeks and conventional therapy plus beraprost sodium tables 2 weeks, n = 30）. The levels of urine microalbumin （UMA）, urine total protein（UTP）, blood lipids and hemorheology were detected before and after 2,4 weeks on corresponding therapy. Results （1） After 2 and 4 weeks, alprostadil group and sequential therapy group significantly decreased the levels of UMA and UTP than before（ P 〈0.05）. In the 4th week, the levels of UMA and UTP were decreased by an average of 14.0% and 56.6% in sequential therapy group which produced the most obvious reduction of UMA and UTP than control group and alprostadil group（ P 〈0.05）. （2）After 4 weeks, alprostadil group and sequential therapy group significantly lowered triglyceride （TG）, total cholesterol （TC）, low density lipoprotein- cholesterol（LDL-C） and raised high density lipoprotein-cholesterol（HDL-C） than before（ P 〈0.05）. In sequential therapy group,TG,TC,LDL-C were significantly reduced and HDL-C raised as compared with those in control group and alprostadil group （ P 〈 0.05）. （3） Compared with control group, the plasma viscosity, erythrocyte sedimentation rate,erythrocyte rigidity index and plasma fibrinogen in other groups were significantly lower （P 〈 0.05）, the erythrodegeneration indexes were significantly higher（ P 〈0.05）. However, sequential therapy group produced more significant change than alprostadil group（ P 〈0.05）. Conclusion Sequential therapy of alprostadil may effectively and safely ameliorate the levels of blood lipids and hemorheology through the reduction of urinary albumin in patients with clinical stage diabetic nephropathy.