非诺贝特治疗糖尿病视网膜病变合并肾病的临床研究

Fenofibrate for diabetic retinopathy combined with diabetic nephropathy

目的观察非诺贝特治疗糖尿病视网膜病变合并肾病的临床疗效。方法 28例(56眼)2型糖尿病患者并发糖尿病视网膜病及肾病在控制血糖基础上随机分为A、B两组。A组(对照组,14例28眼)口服安慰剂Vit C片0.1 g;B组(试验组,14例28眼)口服非诺贝特片0.2 g;均为每天3次,饭前0.5 h口服,连续用42 d,观察两组治疗前后视力、眼底的变化、血压、肾功能、24 h尿蛋白、尿转铁蛋白、血浆基质金属蛋白酶2(metalloproteinase 2,MMP2)和组织型基质金属蛋白酶抑制剂1(tissue inlaibitor of metalloproteinases 1,TIMP-1)水平。结果治疗前两组患者一般情况比较差异均无统计学意义(均为P>0.05)。治疗42 d后,视力提高32眼,其中A组6眼(占18.7%),B组26眼(占81.3%),两组视力较治疗前改善的眼数比较差异有统计学意义(χ2=12.619,P<0.05);A组患者较治疗前各项指标差异均无统计学意义(t24 h尿蛋白=1.254、tCr=1.302、tBUN=0.539、t尿β=0.926、t4、t2微球蛋白FA=1.026、tFib=0.95ET-1=1.124、tMMP2/TIMP1=0.982,均为P>0.05);B组24 h尿蛋白、肾功能(Cr、BUN、尿β2微球蛋白)、FA、Fib、ET-1和MMP2/TIMP1水平均比治疗前明显降低(t24 h尿蛋白=6.739、tCr=8.378、tBUN=6.264、t尿β2MG=5.542、tFA=7.092、tFib=5.428、tET-1=6.554、tMMP2/TIMP1=8.922,均为P<0.05)。治疗后两组患者各项指标比较差异均有统计学意义水平(t24 h尿蛋白=4.432、t尿β=8.821、t2微球蛋白=5.428、tFA=5.616、tCrBUN=6.482、tFib=5.904、tET-1=9.162、tMMP2/TIMP1=5.342,均为P<0.05)。结论非诺贝特治疗临床期糖尿病视网膜病变及肾病,可提高患者视力,能更有效改善视网膜微循环和肾血流动力学,保护眼底和肾功能。

Objective To observe the effects of fenofibrate on diabetic retinopathy combined with diabetic nephyopathy. Methods Totally 28 patients （56 eyes）with diabetic retinopathy and diabetic nephyopathy were randomly divided into two groups： Group A with placebo vitamin C（0.1 g,once per day）and group B with Fenofibrate （0.5 g,once per day,taldng before meals haft an hour）for 42 days,14 cases in each group. The changed of vision, ocular flmdus, blood pressure,renal function, 24 hours urine protein, urine 132 microglobulin, serum matrix metalloproteinase 2 （MMP2） and tissue inhibitor of met- alloproteinase 1 （ TIMPI ） and endothelin 1 （ ET-1 ） were observed, besuits There was no significant difference in general information before therapy between two groups （ all P 〉 0.05 ）. After therapy for 42 days,the visual acuity in 32 eyes were increased, including 6 eyes （ 18.7% ） in group A,26 eyes （ 81.3% ） in group B, there was statisti- cally significance between group A and B （X2 = 12. 619 ,P 〈 0.05 ）. Compared with before therapy, the above items after therapy in group A had no obvious change （ t24 hours urine protein = 1. 254, tCr = 1. 302, tBUN = 0. 539, tβ2-MQ = 0. 926, tFA = 1. 026, tFib = 0. 954, tET-1 = 1. 124, tMMP2/T/MP1 = 0. 982, all P 〉 0. 05 ）, which in group B obviously decrased （ t24 hours urine protein = 6. 739, tCr = 8. 378, tBUN = 6. 264, tβ2-MG = 5. 542, tFA = 7. 092, tFib = 5. 428, tET-1 = 6. 554, tMMP2/TIMP1 = 8. 922, all P 〈 0. 05 ）, and there were statistical differences between two groups（ t24 hours urine protcin= 4. 432, tβ2-MG = 5. 428, tFA = 5. 616, tCr = 8. 821, tBUN = 6. 482, tFib = 5. 904 ,tET-1 = 9. 162, tMMP2/TMP1 = 5. 342, all P 〈 0.05 ）. Conclusion Fenfibrate for patients with diabetic retinopathy combined with dia- betic nephropathy can obviously improve the vision, retinal microcirculation and renal hemodynamics to protect the ocular fundus and renal function.