骨化三醇联合降糖药物对2型糖尿病肾病患者的疗效分析

Therapeutic effect of calcitriol combined with hypoglycemic drugs on therapeutic effect in patients with type 2 diabetic nephropathy

目的探讨骨化三醇联合降糖药物对2型糖尿病肾病患者的临床疗效。方法2017年1月-2018年6月收集苏州科技城医院收治的糖尿病肾病患者160例,将患者随机分为观察组(n=80)和对照组(n=80),观察组给予降糖药物联合骨化三醇治疗,对照组仅给予降糖药物治疗,观察两组患者临床疗效、炎症反应、骨密度等指标差异。结果两组患者治疗前血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、尿素氮、肌酐、24 h尿微量蛋白、肾小球滤过率、尿白介素-18(IL-18)、尿白介素-1β(IL-1β)、骨密度等差异无统计学意义(P>0.05)。治疗后与对照组比较,观察组患者血清hs-CRP、TNF-α水平均显著降低[(4.37±1.28)vs(6.87±1.55)mg/L,P=0.000;(90.77±26.72)vs(105.85±28.95)ng/L,P=0.001];尿IL-18、IL-1β均显著降低[(103.47±30.88)vs(123.87±37.74)ng/L,P=0.000;(114.83±33.71)vs(138.92±36.61)ng/L,P=0.000];尿素氮降低[(133.84±25.81)vs(158.37±27.12)mmol/L,P=0.000];肌酐降低[(13.72±2.88)vs(15.84±3.02)μmol/L,P=0.000];24 h尿微量蛋白降低[(17.75±3.72)vs(21.75±3.86)g/24 h,P=0.000];肾小球滤过率增高[(92.75±10.46)vs(87.64±11.72)mL/min,P=0.004];骨密度增高[(0.73±0.13)vs(0.68±0.15)g/cm3,P=0.026]。两组患者治疗前后空腹血糖、糖化血红蛋白、血钙等水平差异均无统计学意义(P>0.05)。结论骨化三醇联合降糖药物可改善2型糖尿病肾病患者骨密度,降低炎症反应,改善临床疗效。

ObjectiveTo investigate the therapeutic effect of calcitriol combined with hypoglycemic drugs on patients with type 2 diabetic nephropathy(DN).Methods160 patients with DN admitted to Suzhou Science and Technology City Hospital from January 2017 to June 2018 were randomly divided into an observation group(n=80)and a control group(n=80).The observation group was treated with hypoglycemic drugs combined with calcitriol,while the control group was treated with hypoglycemic drugs only.The differences were compared and observed of clinical efficacy,inflammatory response and bone mineral density between the two groups.ResultsThere were no significant differences in serum high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),urea nitrogen,creatinine,24-hour urinary microprotein,glomerular filtration rate,urinary interleukin-18(IL-18),urinary interleukin-1β(IL-1β)and bone mineral density between the two groups before treatment(P>0.05).After treatment,compared with the control group after treatment,the serum hs-CRP and TNF-αlevels in the observation group were significantly lower[(4.37±1.28)vs(6.87±1.55)mg/L,P=0.000;(90.77±26.72)vs(105.85±28.95)ng/L,P=0.001];urine IL-18 and IL-1βwere significantly lower[(103.47±30.88)vs(123.87±37.74)ng/L,P=0.000;(114.83±33.71)vs(138.92±36.61)ng/L,P=0.000];Urea nitrogen decreased[(133.84±25.81)vs(158.37±27.12)mmol/L,P=0.000];creatinine decreased[(13.72±2.88)vs(15.84±3.02)μmol/L,P=0.000];24-hour urinary microprotein decreased[(17.75±3.72)vs(21.75±3.86)g/24 h,P=0.000];glomerular filtration rate increased[(92.75±10.46)vs(87.64±11.72)ml/min,P=0.004];and bone mineral density increased[(0.73±0.13)vs(0.68±0.15)g/cm3,P=0.026].There was no significant difference in fasting blood sugar,glycosylated hemoglobin and blood calcium between the two groups before and after treatment(P>0.05).ConclusionCalcitriol combined with hypoglycemic drugs were shown to be able to improve bone mineral density,reducing the inflammation and improving clinical efficacy in patients with type 2 DN.