依帕司他、前列地尔、罗格列酮联合治疗对糖尿病肾病患者肾功能及炎性因子的影响

Effect of epalrestat, alprostadil and rosiglitazone combined treating on renal function and inflammatory cytokines in patients with diabetic nephropathy

目的观察依帕司他、前列地尔、罗格列酮联合治疗对糖尿病肾病患者肾功能和炎性因子的影响。方法选择126例2型糖尿病肾病患者,根据治疗方案随机平均分为A组(依帕司他+前列地尔+罗格列酮组)、B组(依帕司他+前列地尔组)、C组(依帕司他+罗格列酮组),均治疗8周。疗程结束后,观察三组治疗的临床疗效,同时测定治疗前后血肌酐、尿素氮、尿清蛋白排泄率、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)。结果A组治疗的总有效率为95.23%,明显高于B组和C组的78.57%、80.95%,差异均有统计学意义(χ2分别=5.13、4.09,P均<0.05)。三组患者治疗后空腹血糖、尿素氮、尿清蛋白排泄率、CRP、TNF-α、IL-6均较治疗前明显降低,差异均有统计学意义(t分别=17.01、15.61、20.67、12.12、23.75、10.69;6.35、5.79、6.13、7.37、9.86、5.23;6.97、5.35、6.01、6.66、8.16、5.12,P均<0.05),但A组较B组和C组降低更明显,差异均有统计学意义(t分别=7.60、9.67、11.53、5.65、11.36、5.26;6.56、9.72、12.46、7.68、12.03、6.01,P均<0.05)。结论依帕司他、前列地尔、罗格列酮联合治疗糖尿病肾病临床疗效确切,能明显改善肾功能,降低炎性因子水平。

Objective To observe effect of epalrestat, alprostadil and rosiglitazone combined treating on renal function and inflammatory cytokines in patients with diabetic nephropathy（DN）. Methods A total of 126 cases with DN were ran-domly divided into three groups： group A was given epalrestat, alprostadil and rosiglitazone simultaneously, group B was given epalrestat and alprostadiland simultaneously, group C was given epalrestat and rosiglitazone simultaneously. Eight weeks after treatment, the clinical effect and serum creatinine, blood urea nitrogen, urinary albumin excretion rate, C-re-active protein（CRP）, tumor necrosis factor alpha（TNF-α）, interleukin 6（IL-6） were observed. Results The total effec-tive rate of group A was 95.23% which was significantly higher than that of the group B （78.57%） and group C（80.95%） （χ2=5.13,4.09,P〈0.05）. After treatment, the serum creatinine, blood urea nitrogen, urinary albumin excretion rate, CRP, TNF-α, IL-6 levels of three groups were significantly decreased （t=17.01, 15.61, 20.67, 12.12, 23.75, 10.69;6.35, 5.79, 6.13, 7.37, 9.86, 5.23; 6.97, 5.35, 6.01, 6.66, 8.16, 5.12,P〈0.05）. Compared with group B and group C, the serum creatinine, blood urea nitrogen, urinary albumin excretion rate, CRP, TNF-α, IL-6 levels of group A were significantly different （t=7.60, 9.67, 11.53, 5.65, 11.36, 5.26;6.56, 9.72, 12.46, 7.68, 12.03, 6.01, P〈0.05）. Con-clusion The epalrestat, alprostadil and rosiglitazone combined treatment applying in patients with diabetic nephropathy has definite clinical curative effect. It can significantly improve renal function and lower levels of inflammatory cytokines.