厄贝沙坦联合古拉定对糖尿病肾病的保护作用研究

Clinic effects of irbesartan combined with glutathione sodium on kidney in patients with diabetic nephropathy

目的:观察厄贝沙坦联合古拉定对糖尿病肾病(DN)氧化应激状态的影响,以探讨其在DN治疗中的肾脏保护作用。方法:回顾性分析本院2010年7月至2011年12月收治的120例2型DN(Ⅲ期)患者临床资料,患者分为:常规治疗组(A,n=34)、厄贝沙坦治疗组(B,n=42)和厄贝沙坦联合古拉定治疗组(C,n=44)。观察治疗前和治疗后24h尿蛋白定量、空腹血糖(FGB)、甘油三酯(TG)、血尿素氮(BUN)、血肌酐(SCr)、血钾(K+)的变化,分光分析法检测超氧化物歧化酶(SOD)活性,比色法检测丙二醛(MDA)的表达水平。结果:各组24h尿蛋白定量、FGB、BUN、SCr治疗后较治疗前有显著改善(P<0.05),而TG、K+治疗前后无显著性变化(P>0.05)。B组治疗后24h尿蛋白定量、BUN、SCr较A组治疗后显著改善(P<0.05),C组治疗后24h尿蛋白定量、BUN、SCr较B组治疗后亦显著改善(P<0.05)。C组治疗后较治疗前SOD活性显著升高(P<0.05),MDA表达水平显著减低(P<0.01),而A和B组未见上述变化(P>0.05)。A、B和C组的总有效率分别为44.1%、61.9%和81.8%,C组显著优于A和B组(P<0.05)。结论:厄贝沙坦联合古拉定提高了DN患者体内SOD活性和降低了MDA的表达,改善了患者的氧化应激状态,并可进一步降低24h尿蛋白定量,从而对肾脏起到一定的保护作用。

AIM： To investigate the effects of irbesartan combined with glutathione sodium on oxidative stress in patients with diabetic ne phropathy（DN） and to explore its function in the protection of kidney. METHODS： A total of 120 cases of DN were retrospectively analyzed in this study. The patients were divided into three groups： normal treatment group （A, n = 34）, irbesartan treatment group（B, n=42） , irbesar tan combined with glutathione sodium treatment group（C, n-=44）. The 24 h urine protein quan- titation, FGB, TG, BUN, SCr, K＋ were deter mined before and after treatment. The activity of SOD was detected by spectrophotometer. The expression of MDA was detected by chromatom etry. RESULTS：The 24 h urine protein quantita tion, FGB, BUN, and SCr became better after different treatment （P〈 0.05）. However, the TG and K＋ were not changed after different treatment（P〉0.05）. The changes of 24 h urine protein quantitation, FGB, BUN, and SCr were better in group B than those in group A（P〈0.05）. The changes of 24 h urine protein quanti tation, FGB, BUN, and SCr were better in group C than those in group B（P〈0.05）. After treatment, the SOD activity was elevated and the expression of MDA was decreased in group C. However ,no change was found in group A and B（P〉0.05）. The total effective rate in group A, B, and C was 44.1%, 61.9%, and 81.8%, respectively. The total effective rate in group C was higher than that in group A and B （P〈0.05）. CONCLUSION ： Irhesartan combined with glutathione sodium treatment significantly increases the activity of SOD and decreases the levels of MDA in patient with DN, which down regulates oxidative stress, decreases urine pro tein quantitation, and shows protective function of of kendey.