前列地尔、银杏达莫治疗糖尿病肾病的疗效及最佳剂量研究

Efficacy and optimal dose of alprostadil and ginkgo dipyridamole in the treatment of diabetic nephropathy

目的观察前列地尔联合银杏达莫治疗糖尿病肾病的疗效及前列地尔的最佳剂量。方法选取96例糖尿病肾病患者,按随机数表法分为A组、B组、C组3组,每组32例。三组均采取常规降糖、降压、降脂、降尿蛋白治疗。A组单独采用银杏达莫注射液治疗,B组与C组在银杏达莫注射液基础上分别联合常规剂量与大剂量前列地尔注射液,三组均连续治疗1个月。比较三组治疗前后24 h尿蛋白定量、尿素氮(BUN)、内生肌酐清除率(Ccr)、白细胞介素6(IL-6)、超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH)水平。结果治疗前,三组患者24 h尿蛋白定量、BUN、Ccr、IL-6、hs-CRP、TNF-α、MDA、SOD、GSH水平比较差异无统计学意义(P> 0. 05)。治疗后,三组患者24 h尿蛋白定量、BUN、IL-6、hs-CRP、TNF-α、MDA水平均较治疗前下降,且B组、C组低于A组,C组低于B组(P <0. 05);治疗后,三组患者Ccr、SOD、GSH水平较治疗前升高,且B组、C组高于A组,C组高于B组(P <0. 05)。结论前列地尔联合银杏达莫治疗糖尿病肾病可有效改善患者肾功能、抑制炎性细胞因子、减轻氧化应激,效果优于单用银杏达莫,且银杏达莫联合大剂量前列地尔的疗效优于常规剂量,不良反应未见明显增加。

Objective To observe the efficacy of alprostadil in combination with ginkgo dipyridamole for diabetic nephropathy and the optimal dose of alprostadil. Methods A total of 96 patients with diabetic nephropathy were selected and divided into group A,group B and group C according to the random number table method,with 32 cases in each group. All the three groups were treated with conventional hypoglycemic,antihypertensive,lipid-lowering,and urine-reducing proteins. Group A was treated with ginkgo dipyridamole injection alone. Group B and group C were treated with ginkgo dipyridamole combined with normal-and high-dose alprostadil. All the three groups were treated for one month. The levels of 24-hour urinary protein quantification,urea nitrogen（ BUN）,endogenous creatinine clearance（ Ccr）,interleukin-6（ IL-6）,high-sensitivity C-reactive protein（ hs-CRP）,tumor necrosis factor-alpha（ TNF-α）,malondialdehyde（ M DA）,superoxide dismutase（ SOD）,and glutathione peroxidase（ GSH） were compared among the three groups before and after treatment. Results Before treatment,there was no significant difference in 24-hour urinary protein quantitation,BUN,Ccr,IL-6,hs-CRP,TNF-α,M DA,SOD or GSH levels among the three groups（ P〈0. 05）. After treatment,the 24-hour urinary protein quantification,BUN,IL-6,hs-CRP,TNF-α,and M DA levels were decreased（ P〈0. 05）,and those in group B and group C were lower,while the indexes in group C were lower than those of group B（ P〈0. 05）. After treatment,the levels of Ccr,SOD,and GSH in the three groups were increased（ P〈0. 05）,and those in group B and group C were higher,while the indexes in group C were higher than those of group B（ P〈0. 05）. Conclusion Alprostadil combined with ginkgo dipyridamole in the treatment of diabetic nephropathy can effectively improve the renal function,inhibit the inflammatory cytokines,and reduce the oxidative stress. The effect of the combination use is better than ginkgo dipyridamole alone,and high-dose alprostadil combined with ginkgo dipyridamole is better than the normal-dose use,and no significant increase in adverse reactions is found.