羟苯磺酸钙联合胰岛素治疗老年人早期糖尿病肾病的临床效果观察

Clinical effects of calcium dobesilate combined with insulin in the treatment of elderly patients with diabeticnephropathy in early stage

目的 探讨羟苯磺酸钙联合胰岛素治疗老年人早期糖尿病肾病临床疗效。方法 选取老年早期糖尿病肾病患者１００例，采用随机数字表法分为对照组（５０例）和观察组（５０例），分别在强化胰岛素干预基础上给予贝那普利单用和贝那普利＋羟苯磺酸钙联合治疗；比较两组治疗前后空腹血糖（ＦＰＧ）、餐后２ｈ血糖（２ｈＰＧ）、血肌酐（Ｓｃｒ）、尿素氮（ＢＵＮ）、２４ｈ尿微量白蛋白（ｍＡｌｂ）、β２ 微球蛋白（β２ＭＧ）、胱抑素Ｃ（ＣｙｓＣ）、超敏Ｃ反应蛋白（ｈｓＣＲＰ）及生存质量测定量表（ＱＬＱＣ３０）评分等。结果 两组治疗后ＦＰＧ和２ｈＰＧ水平差异无统计学意义（Ｐ＞０．０５）；对照组治疗前Ｓｃｒ、ＢＵＮ、ｍＡｌｂ及β２ＭＧ水平分别为（８１．１６± １８９２）ｍｍｏｌ／Ｌ，（５．６３±１．１５）ｍｍｏｌ／Ｌ、（１０５．７１±２１．７７）ｍｇ／２４ｈ、（５４３．４６±７４．７０）μｇ／Ｌ，治疗后Ｓｃｒ、ＢＵＮ、ｍＡｌｂ及β２ＭＧ水平分别为（７８．３５±１４．３５）ｍｍｏｌ／Ｌ、（５．１７±０．９７）ｍｍｏｌ／Ｌ、（６９８４±１４．２４）ｍｇ／２４ｈ、（３９５５６±４２．３８）μｇ／Ｌ；观察组治疗前Ｓｃｒ、ＢＵＮ、ｍＡｌｂ及β２ＭＧ水平分别为（８１．５９±１９．０４）ｍｍｏｌ／Ｌ、（５．５８± １．１３）ｍｍｏｌ／Ｌ、（１０６．３３±２１．８２）ｍｇ／２４ｈ、（５４８．２０±７５．３７）μｇ／Ｌ，治疗后Ｓｃｒ、ＢＵＮ、ｍＡｌｂ及β２ＭＧ水平分别 为（７３．１０±１０．７４）ｍｍｏｌ／Ｌ、（４．６３±０．７１）ｍｍｏｌ／Ｌ、（５２．９２±１０．５２）ｍｇ／２４ｈ、（３３７．８９±２５．０４）μｇ／Ｌ；观察组 治疗后Ｓｃｒ、ＢＵＮ、ｍＡｌｂ及β２ＭＧ水平均显著低于对照组、治疗前（ｔ＝２．４５、２．６６、２．１８、２．４０、２．８２、３１０、２．５８、３．３４、２．６１、３．２０、２．６６、３．０５，均Ｐ＜０．０５）；对照组治疗前ＣｙｓＣ和ｈｓＣＲＰ水平分别为（１．８２±０６７）ｍｇ／Ｌ、（２２．７３±６．５４）ｍｇ／Ｌ，治疗后ＣｙｓＣ和ｈｓＣＲＰ水平分别为（１．５９±０．５０）ｍｇ／Ｌ、（１９．３５±５．６０）ｍｇ／Ｌ；观察组 治疗前ＣｙｓＣ和ｈｓＣＲＰ水平分别为（１．８７±０．７０）ｍｇ／Ｌ、（１．１７±０．２７）ｍｇ／Ｌ，治疗后ＣｙｓＣ和ｈｓＣＲＰ水平分 别为（２２．５８±６．５０）ｍｇ／Ｌ、（１５．８８±４．０３）ｍｇ／Ｌ；观察组治疗后ＣｙｓＣ和ｈｓＣＲＰ水平均显著低于对照组、治疗 前（ｔ＝２．３２、２．６７、２．８５、３．１９、２．６６、３．０２，均Ｐ＜０．０５）；同时对照组治疗前后ＱＯＬＣ３０评分分别为（５２．６５±７．７０）分、（６８．２９±９．８４）分；观察组患者治疗前后ＱＯＬＣ３０评分分别为（５３．２２±７７８）分、（８０．５３±１２．１０）分；观察组治疗后ＱＯＬＣ３０评分显著高于对照组、治疗前（ｔ＝２．７８、３．１５，均Ｐ＜００５）。结论 联合口服药物方案辅助强化胰岛素干预治疗老年人早期糖尿病肾病可有效保护肾脏功能，降低炎性细胞因子水平，且有助于改善日常生活质量。

Objective Toinvestigatetheclinicaleffectsofcalciumdobesilatecombinedwithinsulininthe treatmentofelderlypatientswithdiabeticnephropathyinearlystage.Methods 100elderlypatientswithdiabetic nephropathyinearlystagewerechosen,andtheywererandomlydividedintotwogroupsaccordingtothedigitaltable, eachgroupin50cases.Thecontrolgroupweregivenbenazeprilalone,andtheobservationgroupweregivenbenazepril combinedwithcalciumdobesilateonthebasisofintensiveinsulinintervention.ThelevelsofFPG,2hPG,Scr,BUN, mAlb,β2-MG,Cys-Candhs-CRPandQOL-C30scoresbeforeandaftertreatmentofthetwogroupswere compared.Results TherewerenostatisticallysignificantdifferencesinthelevelsofFPG,2hPGaftertreatment betweenthetwogroups（allP〉0.05）.Beforetreatment,thelevelsofScr,BUN,mAlbandβ2 -MGofthecontrol groupwere（81.16±18.92）mmol/L,（ 5.63±1.15）mmol/L,（105.71±21.77）mg/24h,（543.46±74.70）μg/L, respectively,whichoftheobservationgroupwere（81.59±19.04）mmol/L,（5.58±1.13）mmol/L,（106.33± 2182）mg/24h,（548.20±75.37）μg/L,respectively.Aftertreatment,thelevelsofScr,BUN,mAlbandβ2-MGof 中国基层医药2017年12月第24卷第24期 ChinJPrimMedPharm,December2017,Vol.24,No.24 thecontrolgroupwere（78.35±14.35）mmol/L,（5.17±0.97）mmol/L,（69.84±14.24）mg/24h,（395.56± 4238）μg/L,respectively,whichoftheobservationgroupwere（73.10±10.74）mmol/L,（4.63±0.71）mmol/L, （52.92±10.52）mg/24h,（337.89±25.04）μg/L,respectively.ThelevelsofScr,BUN,mAlbandβ2 -MGafter treatmentoftheobservationgroupweresignificantlylowerthanthoseofthecontrolgroupandbeforetreatment（t= 245,2.66,2.18.2.40;2.82,3.10,2.58.3.34;2.61,3.20;2.66.3.05;allP〈0.05）.Beforetreatment,thelevels ofCys-Candhs-CRPofthecontrolgroupwere（1.82±0.67）mg/L,（22.73±6.54）mg/L,respectively,whichof theobservationgroupwere（1.87±0.70）mg/L,（1.17±0.27）mg/L,respectively.Aftertreatment,thelevelsofCys -Candhs-CRPofthecontrolgroupwere（1.59±0.50）mg/L,（19.35±5.60）mg/L,respectively,whichofthe observationgroupwere（22.58±6.50）mg/L,（15.88±4.03）mg/L,respectively.ThelevelsofCys-Candhs- CRPaftertreatmentoftheobservationgroupweresignificantlylowerthanthoseofthecontrolgroupandbeforeDepartmentofEndocrinology,thePeople′sHospitalofFenghua,Ninbo,Zhejiagn315500,China 【Abstract】 Objective Toinvestigatetheclinicaleffectsofcalciumdobesilatecombinedwithinsulininthe treatmentofelderlypatientswithdiabeticnephropathyinearlystage.Methods 100elderlypatientswithdiabetic nephropathyinearlystagewerechosen,andtheywererandomlydividedintotwogroupsaccordingtothedigitaltable, eachgroupin50cases.Thecontrolgroupweregivenbenazeprilalone,andtheobservationgroupweregivenbenazepril combinedwithcalciumdobesilateonthebasisofintensiveinsulinintervention.ThelevelsofFPG,2hPG,Scr,BUN, mAlb,β2-MG,Cys-Candhs-CRPandQOL-C30scoresbeforeandaftertreatmentofthetwogroupswere compared.Results TherewerenostatisticallysignificantdifferencesinthelevelsofFPG,2hPGaftertreatment betweenthetwogroups（allP〉0.05）.Beforetreatment,thelevelsofScr,BUN,mAlbandβ2 -MGofthecontrol groupwere（81.16±18.92）mmol/L,（ 5.63±1.15）mmol/L,（105.71±21.77）mg/24h,（543.46±74.70）μg/L, respectively,whichoftheobservationgroupwere（81.59±19.04）mmol/L,（5.58±1.13）mmol/L,（106.33± 2182）mg/24h,（548.20±75.37）μg/L,respectively.Aftertreatment,thelevelsofScr,BUN,mAlbandβ2-MGof 中国基层医药2017年12月第24卷第24期 ChinJPrimMedPharm,December2017,Vol.24,No.24 thecontrolgroupwere（78.35±14.35）mmol/L,（5.17±0.97）mmol/L,（69.84±14.24）mg/24h,（395.56± 4238）μg/L,respectively,whichoftheobservationgroupwere（73.10±10.74）mmol/L,（4.63±0.71）mmol/L, （52.92±10.52）mg/24h,（337.89±25.04）μg/L,respectively.ThelevelsofScr,BUN,mAlbandβ2 -MGafter treatmentoftheobservationgroupweresignificantlylowerthanthoseofthecontrolgroupandbeforetreatment（t= 245,2.66,2.18.2.40;2.82,3.10,2.58.3.34;2.61,3.20;2.66.3.05;allP〈0.05）.Beforetreatment,thelevels ofCys-Candhs-CRPofthecontrolgroupwere（1.82±0.67）mg/L,（22.73±6.54）mg/L,respectively,whichof theobservationgroupwere（1.87±0.70）mg/L,（1.17±0.27）mg/L,respectively.Aftertreatment,thelevelsofCys -Candhs-CRPofthecontrolgroupwere（1.59±0.50）mg/L,（19.35±5.60）mg/L,respectively,whichofthe observationgroupwere（22.58±6.50）mg/L,（15.88±4.03）mg/L,respectively.ThelevelsofCys-Candhs- CRPaftertreatmentoftheobservationgroupweresignificantlylowerthanthoseofthecontrolgroupandbefore treatment（t=2.32,2.67;2.85,3.19,2.66,3.02;allP〈0.05）.TheQOL-C30scoresofthecontrolgroupbefore andaftertreatmentwere（52.65±7.70）points,（68.29±9.84）points,respectively.TheQOL-C30scoresofthe observationgroupbeforeandaftertreatmentwere（53.22±7.78）points,（80.53±12.10）points,respectively.The QOL-C30scoresoftheobservationgroupaftertreatmentweresignificantlyhigherthanthoseofthecontrolgroupand beforetreatment（t=2.38,2.78,3.15,allP〈0.05）.Conclusion Bigeminydrugregimenassistedwithintensive insulininterventioninthetreatmentofelderlypatientswithdiabeticnephropathyinearlystagecanefficientlyprotect renalfunction,reducethelevelsofinflammatorycytokinesandishelpfultoimprovethequalityoflife.