前列腺素类药物序贯疗法对糖尿病肾病患者血液和尿液样本中肾功能指标的影响

Effect of sequential therapy of prostaglandins on renal function indexes in blood and urine specimens of patients with diabetic nephropathy

目的:研究前列腺素类药物序贯疗法对糖尿病肾病患者血液和尿液样本中肾功能指标的影响。方法:选择糖尿病肾病患者(IV期)96例作为本次研究的对象,随机分为对照组(A组)、前列地尔组(B组)、贝前列腺素钠组(C组)和序贯治疗组(D组),行肾脏彩超检查,测定24h尿液样本中微量白蛋白、总蛋白含量、6-酮前列素F1α(6-keto-PGF1α)和血栓素B2(TXB2)的含量以及血清样本中肌酐(Cr)、尿素氮(BUN)、6-keto-PGF1α、TXB2、胱抑素C(CysC)、视黄醇结合蛋白(RBP)含量。结果:B、C、D三组患者肾血流量高于A组且D组患者的肾血流量高于B、C两组;B、C、D三组患者的24h尿微量白蛋白、总蛋白、TXB2含量以及血清BUN、Cr、CysC、RBP含量均显著低于治疗前(*P<0.05),B、C、D三组患者的血清和尿液6-keto-PGF1α含量均显著高于治疗前(*P<0.05);D组患者治疗后的24h尿微量白蛋白、总蛋白、TXB2含量以及血清BUN、Cr、CysC、RBP含量均显著低于B组(b P<0.05)和C组(c P<0.05),D组患者治疗后的血清和尿液6-keto-PGF1α含量显著高于B组(b P<0.05)和C组(c P<0.05)。结论:前列地尔序贯疗法能够保护糖尿病肾病患者的肾功能,减轻蛋白尿、改善肾小球滤过功能以及微循环障碍、抑制血小板激活。

Objective： To study the effect of sequential therapy of prostaglandins on renal function indexes in blood and urine specimens of patients with diabetic nephropathy. Methods： A total of 96 patients with diabetic nephropathy（ IV） were selected as the subjects of the study and randomly divided into control group（ group A）,alprostadil group（ group B）,beraprost sodium group（ group C） and sequential therapy group（ group D）,renal color Doppler ultrasound was carried out,and trace albumin,total protein,6-keto-prostaglandin F1α（ 6-keto-PGF1α） and thromboxane B2（ TXB2） levels in 24 h urine specimens as well as creatinine（ Cr）,blood urea nitrogen（ BUN）,6-keto-PGF1α,TXB2,cystatin C（ CysC）,retinol-binding protein（ RBP） levels in blood specimens were determined. Results： Renal blood flow of group B,C and D were higher than that of group A and renal blood flow of group D was higher than those of group B and C; 24 h urine trace albumin,total protein and TXB2 levels as well as serum BUN,Cr,CysC and RBP levels of group B,C and D were significantly lower than those before treatment（ P〈0. 05）,and serum and urine 6-keto-PGF1α levels of group B,C and D were significantly higher than those before treatment（ P〈0. 05）; 24 h urine trace albumin,total protein and TXB2 levels as well as serum BUN,Cr,CysC and RBP levels of group D group were significantly lower than those of group B（ P〈0. 05）and group C（ P〈0. 05）,and serum and urine 6-keto-PGF1α levels of group D after treatment were significantly higher than those of group B（ P〈0. 05） and group C（ P〈0. 05）. Conclusions： Sequential therapy of alprostadil can protect renal function in patients with diabetic nephropathy,reduce proteinuria,improve glomerular filtration function and microcirculation disturbance,and inhibit platelet activation.