舒洛地特联合格列齐特对老年糖尿病肾病血管内皮功能的影响

Effect of sulodexide combined with gliclazide on vascular endothelial function in elderly patients with diabetic nephropathy

目的探讨舒洛地特联合格列齐特对老年糖尿病肾病血管内皮生长因子及内皮素的影响。方法老年糖尿病肾病患者90例,随机分为观察组和对照组各45例;对照组在常规治疗基础上给予格列齐特80～320 mg,1次/d;观察组在对照组治疗基础上加用舒洛地特1粒/次,2次/d。治疗3个月后,比较2组疗效以及血糖、尿白蛋白/肌酐比值、细胞内皮功能和药物不良反应等。结果治疗3个月后,观察组总有效率(88.9%)高于对照组(66.7%)(P<0.05),空腹血糖[(6.5±1.2)mmol/L]、糖化血红蛋白[(7.2±1.1)%]、餐后2 h血糖[(8.2±2.1)mmol/L]、尿白蛋白/肌酐比值[(100.5±10.2)g/mg]、血清血管内皮生长因子[(144.3±23.5)ng/L]和内皮素[(91.7±15.1)ng/L]水平低于对照组[(7.2±1.3)mmol/L、(8.0±1.3)%、(9.0±2.5)mmol/L、(116.3±11.1)g/mg、(178.9±28.2)ng/L、(103.5±16.2)ng/L](P<0.05),循环内皮祖细胞数目[(1 387±111)细胞数/mL]高于对照组[(1 236±107)细胞数/mL](P<0.05);2组均无药物不良反应发生。结论舒洛地特联合格列齐特治疗老年糖尿病肾病安全性良好,可有效改善患者血管内皮功能,降低内皮素水平。

Objective To explore the effect of sulodexide combined with gliclazide on vascular endothelial growth factor(VEGF) and endothelin in elderly patients with diabetic nephropathy(DN). Methods Ninety DN patients were randomly divided into two groups, with 45 patients in each group. Control group was given gliclazide 80 to 320 mg once a day besides the conventional therapy, and observation group was given sulodexide one pill per time, twice a day, besides the therapy in control group. The therapeutic effect, fasting plasma glucose(FPG), urinary albumin/creatinine ratio(UACR), endothelial function and adverse reactions of drugs were compared between two groups after three-month treatment. Results The total effect was significantly higher in observation group(88.9%) than that in control group(66.7%)(P<0.05), the levels of FPG((6.5±1.2) mmol/L), glycosylated hemoglobin((7.2±1.1)%), 2 h postprandial plasm glucose((8.2±2.1) mmol/L) UACR((100.5±10.2) g/mg), VEGF((144.3±23.5) ng/L) and endothelin((91.7±15.1) ng/L) in observation group were significantly lower than those in control group((7.2±1.3) mmol/L,(8.0±1.3)%,(9.0±2.5) mmol/L,(116.3±11.1) g/mg,(178.9±28.2) ng/L,(103.5±16.2) ng/L)(P<0.05), while the number of circulating endothelial progenitor cells((1 387±111) cells/mL) was significantly larger than that in control group((1 236±107) cells/mL)(P<0.05). No adverse reactions occurred in two groups. Conclusion Sulodexide combined with gliclazide can effectively improve endothelial function and reduce endothelin level, and it is safe for elderly DN patients.