前列地尔治疗Ⅳ期糖尿病肾病的疗效观察

Effect of Alprostadil on Patients with Diabetic Nephropathy of Stage Ⅳ

目的观察前列地尔治疗Ⅳ期糖尿病肾病(DN)的疗效。方法选取2011年2—12月在我院内分泌科住院的Ⅳ期DN患者78例,随机分为对照组(38例)和前列地尔组(40例)。两组均常规给予糖尿病饮食、运动及降血压、降血脂、降血糖治疗;待患者血糖、血脂、血压稳定1周后,前列地尔组另给予前列地尔20μg加入0.9%氯化钠注射液100 ml中静脉滴注,1次/d,7 d为1个疗程。比较治疗前及治疗3个月后两组患者的血压、糖化血红蛋白、血脂、血尿素氮、血清肌酐、尿清蛋白定量及血β2微球蛋白(β2-MG)水平。两组间比较采用成组t检验。结果治疗前两组患者血压、糖化血红蛋白、血脂、血尿素氮、血清肌酐、尿清蛋白定量、血β2-MG水平比较,差异均无统计学意义(P>0.05);治疗后前列地尔组患者尿清蛋白定量和血β2-MG水平低于对照组〔尿清蛋白:(343±61)mg/24 h与(366±54)mg/24 h;血β2-MG(458±107)mg/24 h与(471±111)mg/24 h〕,差异均有统计学意义(P<0.05)。结论静脉应用前列地尔治疗Ⅳ期DN患者,短期能减少患者尿清蛋白量和血β2-MG水平,从而改善DN患者的预后。

Objective To investigate the effect of alprostadil on patients with diabetic nephropathy （DN） of stage IV. Methods 78 DN patients at stage IV admitted to endocrine department of our hospital from February to December in 2011 were randomly divided into control group （38 cases） and alprostadil group （40 cases） . The two groups were both given diabetic diets, treatment of exercise, antihypertension, antilipidemic and antidiabetics. The alprostadil group was given 20 μg alprostadil in 100 ml 0. 9% sodium chloride injection one time a day for 7 days. The blood pressure, HbAlc, blood lipid, blood urea nitrogen, serum creatinine, 24 h urinary albumin and β2 -microglobulin （β2 -MG） were compared between the two groups before treatment and three months after treatment, t test was used in the comparison. Results The blood pressure, HbA,o, blood lipid, blood urea nitrogen, serum creatinine, 24 h urinary albumin and β2 - MG showed no statistically significant difference before treatment （P 〉 0. 05） . After treatment, the 24 h urinary albumin and β2 - MG in alprostadil group were significantly lower than those in the control group [urinary albumin： （343 ±61） mg/24 h vs. （366 ±54） mg/24 h; β2 -MG： （458 ±107） mg/24 h vs. （471 ± 111 ） mg/24 hi （P 〈 0. 05 ） . Conclusion A Short - term intravenous application of alprostadil can decrease 24 h urinary albumin and β2 -MG in patients with diabetic nephropathy at stage IV, thus improving the patients＇ prognosis.