羟苯磺酸钙联合前列地尔对早期糖尿病肾病患者血管内皮功能的影响

Clinicaleffect of Calcium Dobesilatecombinated with Alprostadilin the Vascular endothelium of patients with Diabetic nephropathy

目的:研究羟苯磺酸钙联合前列地尔治疗早期糖尿病肾病(DN)患者的血管内皮功能、舒缩功能的影响,并评估其临床疗效,记录不良反应。方法:收集来我院就诊的早期DN患者84例,分为对照组与观察组各42例。两组均降糖治疗(二甲双胍等)+改善循环(羟苯磺酸钙),观察组在此基础上给予前列地尔,两组均连续治疗1个月。检测治疗前后两组空腹血糖(FBG)、餐后2小时血糖(2 hPBG)、一氧化氮(NO)、内皮素-1(ET-1)、血管内皮生长因子(VEGF)、肱动脉血流介导的内皮依赖性血管舒张功能(FDM)、硝酸甘油所介导的非内皮依赖性血管舒张功能(NMD)、肾小球滤过率(GFR)、血清肌酐(Cr)、血清尿素氮(BUN)、尿微量白蛋白肌酐比值(UACR)、醛固酮排泄率(AER)、尿蛋白排泄率(UAER),记录治疗过程中的不良反应。结果:治疗后两组FBG、PBG均低于治疗前,差异有统计学意义(P<0.05);治疗后两组FBG、PBG比较,差异无统计学意义(P>0.05);治疗后两组的ET-1、VEGF均低于治疗前,且观察组的ET-1、VEGF均低于对照组,差异均有统计学意义(P<0.05),治疗后两组NO均高于治疗前,且观察组NO高于对照组,差异均有统计学意义(P<0.05);治疗后两组FDM、NDM均高于治疗前,且观察组FDM、NDM高于对照组,差异均有统计学意义(P<0.05);治疗后两组GFR、Cr、BUN、AER、UACR、UAER均低于治疗前,且观察组上述指标均低于对照组,差异均有统计学意义(P<0.05)。治疗过程中两组均未发生严重不良反应(AEs),仅出现轻度胃肠道反应、皮疹、干咳等,且两组发生率比较,差异无统计学意义(P>0.05)。结论:在早期DN患者在降糖、改善循环的治疗基础上加用前列地尔能很好改善血管内皮功能,提高临床疗效,安全可靠。

Objective:To research the effect of calcium dobesilatecombinated with alprostadilon the changes of vascular endothelium function in patients with diabetic nephropathy(DN),and assess the clinical effect and record the untoward effect. Methods:Selceting 120 patients with DN,then they were randomly divided into control group(n=60)and observation group(n =60).Two groups were given hypoglycemic(melbinum)+improving circulatory(calcium dobesilate),and observation group were given alprostadilon the basic,they were treated 30 days.After treatment,we observedthe changes of fasting plasma glucose( FBG),2-hour postprandial blood glucose(2hPBG),the factot of vasomotion angiokinesis(nitrogen oxide(NO),endothelin- 1(ET-1),vascular endothelial growth factor(VEGF)),diastolic function of vascular endothelium (flow mediated dilation( FMD),nitroglycerin mediated dilation(NMD),renal function index(glomerular filtration rate(GFR),creatinine(Cr), blood urea nitrogen(BUN),albumin excrete rate(AER),urinary albumin creatinine ratio(UACR),urinary albumin evacuate ratio(UAER),and record the untoward effect.Results:After treatment,the FBG,2hPBG were both lower than before treatment in both groups,the difference had statistical significance(P<0.05),and the FBG,2hPBG in the observation group were lower than the control group,and the difference had statistical significance(P<0.05).After treatment,the ET-1,VEGF were both lower than before treatment in both groups,the difference had statistical significance(P<0.05),and theET-1,VEGF in the observation group were lower than the control group,and the difference had statistical significance(P<0.05).After treatment, the NO,FDM,NDM were higher than before treatment in both groups,the difference had statistical significance(P< 0.05),and theNO,FDM,NDM in the observation group were higher than the control group,and the difference had statistical significance(P<0.05).After treatment,the GFR,Cr,BUN,AER,UACR,and UAER were both lower than before treatment in both groups,the difference had statistical significance(P<0.05),and the GFR,Cr,BUN,UACR,and UAER in the observation group were lower than the control group,and the difference had statistical significance(P<0.05).Conclusions: Treatment of the patients with DNbeside improving the cardiovascular system and hypoglycemic,giving the alprostadil can improve the function of vascular endothelium,rasing the clinical effect and safety.