舒洛地特联合替米沙坦对原发性膜性肾病患者尿蛋白、血浆蛋白水平及肝肾功能的影响

Effects of sulodexide combined with telmisartan on urinary protein, plasma protein and liver and kidney function in patients with primary membranous nephropathy

目的探讨舒洛地特联合替米沙坦对原发性膜性肾病患者尿蛋白、血浆蛋白水平及肝肾功能的影响。方法回顾性分析2014年5月—2016年3月期间收治的69例原发性膜性肾病患者的病例资料,34例予以舒洛地特治疗(对照组),35例予以舒洛地特+替米沙坦治疗(观察组),观察临床疗效。结果 2组治疗前24 h尿蛋白定量、血浆白蛋白及肝功能指标和肾功能指标比较,差异无统计学意义(P>0.05)。2组治疗后1个月24 h尿蛋白定量均明显下降,血浆白蛋白水平明显较治疗前升高,组内治疗前后比较差异均有统计学意义(P<0.05),且治疗后1个月组间比较差异有统计意义(P<0.05)。治疗后1个月,2组血清肌酐(serum creatinine,Scr)、胱抑素C(Cystatin C,Cys-C)及肾动脉搏动指数(pulse index,PI)均显著改善,观察组改善效果较对照组优,组间比较差异有统计学意义(P<0.05);且治疗后1个月2组谷丙转氨酶(ALT),谷草转氨酶(AST)水平均未见明显变化,组间差异无统计学意义(P>0.05)。观察组总有效率高于对照组,组间差异有统计学意义(P<0.05)。结论舒洛地特联合替米沙坦治疗原发性膜性肾病可显著降低尿蛋白,提高血浆白蛋白水平,有效改善肾功能,且对肝功能影响较小,安全性高。

Objective To invest igate the effect of sulodexide combined with telmisar tan onurinary protein, plasma protein and liver and kidney funct ion in pat ients with pr imary membranous nephropathy.Methods The clinical data of 69 pr imary membranous nephropathy patients t reated in our hospital between May 2014 and March 2016 was ret rospect ively analyzed. These pat ients were randomly divided into two groups： the cont rol g roup with 34 cases who were treated with sulodexide alone, and the observation group with 35 cases who received sulodexide combined wit h telmisar tan. The clinical efficacy was observed.Results Before t reatment, there was no statistically signif icant difference in 24 h ur inar y protein content,plasma albumin, or liver and renal funct ion indexes between the two groups（P〈0.05）. One month af ter treatment, 24 h ur inar y protein decreased sharply in both g roups, whi le plasma albumi n levels increased evidently, and the difference was of statistical signi ficance（P〈0.05）. One month after treatment, Scr,Cys-C and PI of the renal artery were obviously improved in both groups, especially in the observation group, and the difference was significant between the two groups（P〈0.05）, but ALT and AST did not change signif icantly within either group or between the two groups（P〉0.05）. There were no signif icant changes in the level of glutamic pyruvic transaminase（ALT） and glutamic pyruvic aminot ransferase（AST） in the 2 groups af ter 1 months of treatment, and there was no significant difference between the groups（P〉0.05）. The total effective rate of the observation group, which was higher than the control group, and the difference between the two groups was significant（P〈0.05）. Conclusion Sulodexide combined with telmisartan for primary membranous nephropathy can apparently reduce urinary protein, increase serum albumin levels, promote renal function, and have less inf luence on liver function.the difference was significant between the two groups （P〈0.05）, but ALT and AST did not change significantly within either group or between the two groups （P〉0.05）. There were no significant changes in the level of glutamic pyruvic transaminase （ALT） and glutamic pyruvic aminotransferase （AST） in the 2 groups after 1 months of treatment, and there was no significant difference between the groups （P〉0.05）. The total effective rate of the observation group, which was higher than the control group, and the difference between the two groups was significant （P〈0.05）. ConclusionSulodexide combined with telmisartan for primary membranous nephropathy canapparently reduce urinary protein, increase serum albumin levels, promote renal function, and have less influence onliver function.