氯沙坦钾联合前列地尔治疗早期糖尿病肾病的疗效研究

The study of losartan potassium combined with alprostadil in the treatment of patient with early diabetic nephropathy

目的 观察氯沙坦钾联合前列地尔治疗早期糖尿病肾病的临床疗效及安全性.方法 选取120例早期糖尿病肾病患者分为A、B、C三组,每组40例,A组静脉滴注前列地尔10 μg加生理盐水50 mL,每日1次;B组口服氯沙坦钾片50 mg,每日1次;C组静脉滴注前列地尔10μg加生理盐水50 mL,联合口服氯沙坦钾片50 mg,每日1次,三组疗程均为3个月,观察治疗前后肾功能（血肌酐、尿素氮）、尿微量蛋白指标（微量白蛋白、24 h尿白蛋白排泄率）、血压、血糖及糖化血红蛋白变化情况.结果 ①与治疗前相比,治疗后三组患者尿微量白蛋白及尿白蛋白排泄率均较治疗前显著降低（P〈0.05）,其中尿微量白蛋白指标下降更显著,C组降低更显著（P〈0.05）,而血清尿素氮、血清肌酐无明显变化;B及C组血压较治疗前明显下降,三组血糖及糖化血红蛋白无明显变化（P〉0.05）;②治疗后A、B和C组临床有效率分别为80％（32/40）、90％（36/40）和97.5％ （39/40）,与A组和B组相比,C组临床有效率显著高于A和B组（P〈0.05）;③A、B、C三组不良反应发生率分别为7.5％ （3/40）,7.5％ （3/40）和10％ （4/40）,差异无统计学意义（P〉0.05）.结论 对早期糖尿病肾病患者,氯沙坦联合前列地尔能改善肾功能,有效减少尿蛋白,延缓病情进展,改善患者预后,安全性好.

Objective To evaluate the clinical efficacy and safety of losartan potassium combined with alprostadil in the treatment of early diabetic nephropathy.Methods A total of 120 patients with early diabetic nephropathy were divided into three groups,40 patients in every group.Patients in group A were given alprostadil 10 μg with 0.9% NaCl 50 mL daily 1 time.patients in group B were given losartan potassium daily 1 time 50 mg.And patients in group C were given alprostadil 10 μg with 0.9% NaC1 50 mL with losartan potassium 50 ng daily 1 time.After 3 months treatment,the clinical efficacy and serum blood urea nitrogen（BUN）,serum creatinine（Scr） and urinary albumin excretion rate（UAER） were observed in three groups.Results ①Compared with before treatment,microalbuminuria and urinary albumin excretion rate in the three groups after treatment were much better improvement than before treatment（P 〈0.05）.Especially the decrease of urine microalbumin index was more significant,the group C decreased significantly （P 〈 0.05）.There was no significant change in serum urea nitrogen and serum creatinine.The blood pressure of group B and group C decreased significantly compared with before treatment.There was no significant change in blood glucose and glycosylated hemoglobin in the three groups （P 〈0.05）.②Total efficacy were 80% （32/40）,90% （36/40）and 97.5 % （39/40） for group A,B and C,without no significant statistical difference （P 〉 0.05）.The BUN,Scr and UAER significantly decreased after treatment among three groups （P 〈 0.05）,group C was lower than other groups after treatment（P 〈 0.05）.③The incidence rates of adverse drug reactions were 7.5% （3/40）,7.5% （3/40） and 10.0% （4/40） for the three groups,with no statistical difference （P 〉 0.05）.Conclusions The clinical efficacy of losartan potassium combined with alprostadil is superior to the single drug in the treatment of early diabetic nephropathy which can decrease the BUN,Scr and UAER.