厄贝沙坦联合增强型体外反搏治疗老年早期糖尿病肾病的疗效观察

Efficacy of Irbesartan Combined with Enhanced External Counterpulsation in the Elderly Patients with Early Diabetic Nephropathy

[目的]探讨厄贝沙坦联合增强型体外反搏治疗老年早期糖尿病肾病（DN）的疗效及对内皮细胞功能的影响.[方法]选取在本院诊治的90例老年早期DN,按照随机数表法分为观察组和对照组,每组45例.对照组常规降糖、降脂,每日口服厄贝沙坦150 mg治疗.观察组在对照组的基础上加体外反搏治疗,每日1次,每次45 min.均连续治疗8周.比较两组治疗前后血肌酐（SCr）、血尿素氮（BUN）、尿微量白蛋白（MA）、β2微球蛋白（β2-MG）、N乙酰D氨基葡萄糖酶（NAG）、血清胱抑素-C（Cys-C）、内皮素-1（ET-1）、一氧化氮（NO）水平.[结果]治疗后,两组患者血SCr、BUN、MA、β2-MG、NAG、Cys-C较治疗前均下降,且观察组明显低于对照组,其差异均有统计学意义（P〈0.05）;观察组ET-1水平明显低于对照组与治疗前,NO水平高于对照组与治疗前,其差异有统计学意义（P〈0.05）.[结论]厄贝沙坦联合增强型体外反搏治疗老年早期DN患者,能有效降低尿蛋白的排泄,改善肾功能,其机制可能与其改善内皮细胞功能有关,值得临床推广应用.

[Objective]To investigate the efficacy of irbesartan combined with enhanced external counterpulsa- tion in the treatment of senile early diabetic nephropathy （DN） and its effect on endothelial cell function.[Methods]A total of 90 elderly patients with early diabetic nephropathy treated in our hospital were selected and randomly divided into the control group（45 cases）and the observation group（45 cases）. Patients in the control group re-ceived routine hypoglycemic and lipid-lowering treatment plus a daily 150 mg irbesartan administered orally. Mean-while, the observation group was given enhanced external counterpulsation （once daily for 45 minutes） on the basis of the conventional treatment received by the control group.All patients were treated for 8 weeks. The changes of serum creatinine （Scr）, blood urea nitrogen （BUN）, microalbuminuria （MA）, beta2 microglobulin （132-MG）, N acetyl D glucosamine enzyme （NAG）, serum cystatin C （Cys-C）, endothelin -1 （ET-1） and nitric oxide （NO） were compared between the two groups before and after treatment.[Results]After treatment, the levels of SCr, BUN, MA, 2-MG, NAG, and Cys-C in the blood of both groups＇ patients were decreased; the decrease in the ob- servation group was significantly lower than in the control group （P〈0.05）. The level of ET-1 in the observation group after treatment was significantly lower than that before treatment, and it was lower than that of the control group as well （ P〈0.05）.The level of NO in the observation groups was significantly higher than that in the control group before treatment. The difference was statistically significant （ P〈0.05）. [Conclusion]Irbesartan com- bining with enhanced external counterpulsation in the treatment of elderly patients with DN can effectively reduce the excretion of urinary protein and improve renal function.The mechanism may be related to the improvement of endothelial cell function.