丹参酮Ⅱ_A磺酸钠注射液联合门冬胰岛素30注射液治疗糖尿病肾病的疗效观察

Clinical observation of Tanshinone Ⅱ_A sulfonate Injection combined with Insulin Aspart 30 Injection in treatment of diabetic nephropathy

目的探讨丹参酮IIA磺酸钠注射液联合门冬胰岛素30注射液治疗糖尿病肾病的临床疗效。方法选取2015年6月—2016年12月在三门峡市中心医院确诊的糖尿病肾病患者120例,按照数表法将患者随机分为对照组和治疗组,每组各60例。对照组于早、晚餐前皮下注射门冬胰岛素30注射液。未用过胰岛素的患者,门冬胰岛素30注射液起始剂量为10~16 U/d,之前已使用胰岛素的患者根据之前用量和血糖控制情况适当调整。治疗组患者在对照组基础上静脉滴注丹参酮IIA磺酸钠注射液,将40 mg丹参酮IIA磺酸钠注射液溶于250 m L生理盐水中,1次/d。两组患者均连续给药2周。观察两组临床疗效,比较治疗前后两组患者的血糖指标、肾功能指标、肾纤维化指标和肾血流量参数。结果治疗后,对照组和治疗组的临床总有效率分别为71.67%和88.33%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组空腹血糖、餐后2 h血糖和糖化血红蛋白水平均明显下降,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗后,治疗组血糖指标水平明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者血肌酐、尿素氮和24 h尿蛋白水平均明显下降,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗后,治疗组肾功能指标水平明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组血清层黏连蛋白(LN)、透明质酸(HA)、III型前胶原(PCIII)和IV型胶原(IV C)水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗后,治疗组肾纤维化指标水平均明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组肾内段动脉收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)显著上升,阻力指数(RI)、搏动指数(PI)水平明显下降,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗后,治疗组肾脏血流参数水平明显优于对照组,两组比较差异具有统计学意义(P<0.05)。结论丹参酮IIA磺酸钠注射液联合门冬胰岛素30注射液治疗糖尿病肾病具有较好的临床疗效,能够降低血糖指标,改善肾功能、肾纤维化指标和血流动力学参数,具有一定临床应用价值。

Objective To investigate the clinical efficacy of Tanshinone ⅡA sulfonate Injection combined with Insulin Aspart 30 Injection in treatment of diabetic nephropathy. Methods Patients（120 cases） with diabetic nephropathy in Sanmenxia Central Hospital from June 2015 to December 2016 were randomly divided into control and treatment groups, and each group had 60 cases. Patients in the control group were sc administered with Insulin Aspart 30 Injection before breakfast and dinner, patients who had not used insulin, the starting dose of Insulin Aspart 30 Injection was 10 — 16 U/d, but patients who had previously used insulin had appropriate adjustments based on previous dosage and glycemic control. Patients in the treatment group were iv administered with Tanshinone ⅡA sulfonate Injection on the basis of the control group, 40 m L was added to 250 m L normal saline, once daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, and the blood glucose indexes, renal function indexes, renal fibrosis indexes, and the renal blood flow parameters in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups was 71.67% and 88.33%, respectively, and there were differences between two groups（P 〈 0.05）. After treatment, fasting plasma glucose, 2 h postprandial blood glucose, and glycosylated hemoglobin levels in two groups were significantly decreased, and the difference was statistically significant in the same group（P 〈 0.05）. And the blood glucose indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P 〈 0.05）. After treatment, serum creatinine, urea nitrogen, and 24 h urine protein levels in two groups were significantly decreased, and the difference was statistically significant in the same group（P 〈 0.05）. And the renal function indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P 〈 0.05）. After treatment, LN, HA, PCⅡI, and IVC levels in treatment group were significantly decreased, and the difference was statistically significant in the same group（P 〈 0.05）. And the renal fibrosis indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P 〈 0.05）. After treatment, PSV and EDV levels in treatment group were significantly increased, but RI and PI levels were significantly decreased, and the difference was statistically significant in the same group（P 〈 0.05）. And the renal blood flow parameters in the treatment group after treatment were significantly better than those in the control group（P 〈 0.05）. Conclusion Tanshinone ⅡA sulfonate Injection combined with Insulin Aspart 30 Injection has clinical curative effect in treatment of diabetic nephropathy, can reduce the blood glucose indexes, improve the renal function indexes, renal fibrosis indexes, and the renal blood flow parameters, which has a certain clinical application value.