坎地沙坦酯联合依那普利对早期糖尿病肾病患者血清炎性因子水平及24h尿微量白蛋白排泄率的影响

Effect of candesartan cilexetil plus enalapril on serum inflammatory factors and 24-h urinary albumin excretion rate in patients with early diabetic nephropathy

目的坎地沙坦酯联合依那普利对早期糖尿病肾病(DN)患者血清炎性因子水平及24h尿微量白蛋白排泄率(UAER)的影响。方法选取2015年9月-2016年9月在沈阳市某医院就诊的106例早期DN患者为研究对象。采用随机数字表法将患者随机分为对照组与研究组,每组53例。对照组患者口服坎地沙坦酯进行治疗,研究组患者在对照组基础上加用依那普利。治疗前及治疗3个月时,比较2组患者白介素-6(IL-6)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)及高敏C反应蛋白(hs-CRP)等血清炎性因子水平、UAER及肾功能指标。治疗3个月时,比较2组患者不良反应发生情况。结果治疗前,2组患者IL-6,IL-1β,TNF-α及hs-CRP水平比较,差异无统计学意义(P>0.05);治疗后,2组患者IL-6,IL-1β,TNF-α及hs-CRP水平均低于治疗前,且研究组患者均低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者UAER,血尿素氮(BUN)及血肌酐(SCr)水平比较,差异无统计学意义(P>0.05);治疗后,2组患者UAER,BUN及SCr水平均低于治疗前,且研究组患者均低于对照组,差异均有统计学意义(P<0.05)。2组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论坎地沙坦酯联合依那普利治疗早期DN,可有效改善患者机体的微炎症状态,降低UAER,延缓病情进展,值得临床推广应用。

Objective To assess the effect of candesartan cilexetil plus enalapril on serum inflammatory factors and 24-h urinary albumin excretion rate（UAER） in patients with early diabetic nephropathy （DN）. Methods A total of 106 patients with early DN who were treated at a Shenyang hospital from September 2015 to Sep- tember 2016 were included in this study. Patients were randomized into the study group （n=53） and the control group （n = 53） by using a random number table. Patients in the control group received oral candesartan cilexetil alone, while those in the study group received candesartan cilexetil plus enalapril. At baseline and Month 3, the levels of serum inflammatory factors including interleukin-6 （IL-6）, interleukin-1β （IL-1β）, tumor necrosis factor-α （TNF-α） and high-sensitivity C-reactive protein （hs-CRP）, as well as UAER and renal functions were assessed and compared between the two groups. Adverse events were also recorded and compared between the two groups after 3-month treatment. Results At baseline, the levels of IL-6, IL-1β, TNF-α and hs-CRP were similar between the two groups （P〈0.05）. At Month 3, the IL-6, IL-1β, TNF-α and hs- CRP levers were decreased compared with those at baseline in both groups; these levels in the study group were significantly lower than those in the control group （P〈0.05）. At baseline, the UAER, blood urea nitro- gen （BUN）, and serum ereatinine （SCr） levels were comparable between the two groups （P〉0.05）. At Month 3, the UAER, BUN and SCr levels were reduced compared with those at baseline in both groups; these levels in the study group were significantly lower than those in the control group （P〈0.05）. The incidence of adverse events were similar between the two groups （P〈0.05）. Conclusion For patients with early DN, candesartan cilexetil combined with enalapril may effectively improve the microinflammation state, reduce UAER, and delay disease progression, which deserves widespread clinical applications.