前列地尔治疗糖尿病早期伴慢性肾病患者的临床效果及对血清相关指标的影响

Clinical effects of alprostadil in the treatment of patients with early diabetic and chronic kidney disease and its influences on serum indexes

目的探讨前列地尔治疗糖尿病早期伴慢性肾病患者临床效果及对血清肌酐(Scr)、尿素氮(BUN)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等指标的影响。方法选取2014年2月至2016年2月该院收治86例糖尿病早期伴慢性肾病患者为研究对象,按照随机数字表法分为研究组43例和对照组43例,对照组给予低钠限盐饮食,控制蛋白摄入量、给予降血糖及血脂药物。研究组在对照组基础上给予前列地尔(10μg,溶入20mL生理盐水中,静脉推注),1次/天。两组患者均连续治疗12周。比较两组患者临床疗效,检测患者治疗前后Scr、BUN、胱抑素C(Cys C)、24h尿蛋白、内生肌酐清率、CRP、IL-6、TNF-α,并计算24h尿蛋白排泄率(UAER)。结果研究组总有效率为95.3%(41/43),对照组总有效率为79.1%(34/43),研究组总有效率显著高于对照组,差异有统计学意义(χ~2=5.108,P=0.024)。治疗后两组患者Scr、BUN、Cys C、24h尿蛋白、UAER、CRP、IL-6、TNF-α明显降低,内生肌酐清率显著升高,与治疗前比较差异具有统计学意义(P<0.05);其中研究组Scr、BUN、Cys C、24h尿蛋白、UAER、CRP、IL-6、TNF-α明显低于对照组,内生肌酐清率显著高于对照组,差异有统计学意义(P<0.05);两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论前列地尔能够显著提高糖尿病早期伴慢性肾病患者的疗效,有利于保护肾功能,改善炎性细胞水平,安全可靠,值得临床推广应用。

Objective To investigate the clinical effects of alprostadil in the treatment of patients with early diabetic and chronic kidney disease and its influences on serum indexes, including serum creatinine（Scr）, urea nitrogen（BUN）, C reactive protein（CRP）, IL-6 and tumor necrosis factor-α（TNF-α） and so on. Methods A total of 86 patients with early diabetic and chronic kidney disease were selected,which were treated in hospital from February 2014 to February 2016,and were divided into the study group（43 ca- ses） and control group（43 cases）. The patients of control group were treated with low sodium salt restriction diet,controlling pro- tein intake, hypolycemic drugs and lipid-lowering agents were given. On the basis of control group, the patients of study group were treated with alprostadil（10 t^g,dissolved in 20 mL saline,intravenous injection）, 1 time per day. The patients of two groups were all treated for 12 weeks in a row. The clinical efficacy and changes of the levels of Scr,BUN,Cys C,24 h urine protein,creatinine clear- ance rate,CRP,IL-6,TNF-α,urine albumin excretion rate（UAER） of two groups were compared. Results After the appropriate treatment, the effective rate of the study group was 95.3% （41/43）, which was significantly higher than that of the 79.1% （34/43） of the control group（x^2=5. 108,P=0. 024）. Scr,BUN,Cys C,24 h urine protein,UAER,CRP,IL-6 and TNF-α of two groups were all significantly lower than before（P〈0. 05） ,and these indicators of the study group were significantly lower than that of the con- trol group（P〈0.05）. And the creatinine clearance rates of the patients of two groups were all significantly higher than before（P〈 0.05） ,which of the study group were significantly higher than that of the control group（P〈0.05）. The adverse reactions of two groups had no statistical significance（P〈0.05）. Conclusion Alprostadil could significantly improve the clinical efficacy of patients with early diabetic and chronic kidney disease,which also could help to protect the kidney function and improve the level of inflam- matory cells. It is also safe and reliable, which makes it worthy of clinical application.