前列地尔对糖尿病肾病患者肾血流参数及纤维化指标的影响

Research about the influence of alprostadil for the renal blood flow parameters and fibrosis Influence of alprostadil on renal blood flow parameters and fibrosis indexes of patients with diabetic nephropathy

目的:观察前列地尔治疗糖尿病肾病疗效及其对患者肾血流参数及纤维化指标表达的影响。方法:随机选取本院收治的80例糖尿病肾病患者为研究对象,并分为对照组40例和观察组40例,其中对照组采用常规治疗,观察组在常规治疗的基础上再增加前列地尔治疗。分别对两组治疗前后的空腹血糖、肾功能相关指标血肌酐、尿素氮、尿白蛋白排泄率以及纤维化标志物基质金属蛋白酶-9(MMP-9)、层粘连蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)和Ⅳ型胶原(ⅣC)进行检测,采用彩色多普勒超声检测于肾内段动脉收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)及搏动指数(PI)。结果:观察组治疗后14、28d,尿素氮和尿白蛋白排泄率均明显低于对照组,PSV、EDV快于对照组,RI和PI则低于对照组,血清MMP-9、HA、LN、PCⅢ和ⅣC水平均低于对照组,差异均具有统计学意义(P<0.05)。结论:前列地尔能改善DN患者肾血流供应,从而有效减缓纤维化发展,保护糖尿病患者的肾功能。

Objective： To observe influence of alprostadil on renal blood flow parameters and fibrosis indexes of patients with diabetic nephropathy. Methods： 80 diabetic nephropathy patients were randomly divided into control group and observa- tion group with 40 cases in each group. The control group was treated by routine therapy; the observation group was also given alprostadil based on conventional treatment. Before and after treatment, fasting blood glucose level, related parameters of renal function including serum creatinine, blood urea nitrogen, urinary albumin excretion rate and fibrosis markers of matrix metal- loproteinase-9 （MMP-9）, hyaluronic acid （HA）, laminin （LN）, Ⅲ procollagen （PCⅢ） and type Ⅳ collagen （IVC）, and peak systolic velocity （PSV）, end diastolic velocity （EDV）, resistance index （RI） and pulsatility index （PI） of renal artery segment were detected and compared between the two groups. Results：14, 28 days after treatment, the blood urea nitrogen, urinary al- bumin excretion rate of observation group were all lower than control group, the PSV and EDV were faster than control group, RI and PI were lower than control group, while the serum levels of MMP-9, HA, LN, PCⅢ, ColⅢand BUN were also sig- nificantly lower than control group（P〈0.05）. Conclusion：Alprostadil can effectively improve renal blood supply for DN, slow fibrosis, thereby improving renal function.