福辛普利联合羟苯磺酸钙治疗老年早期2型糖尿病肾病的临床研究

Fosinopril Combined with Calcium Dobesilate in the Treatment of Older Patients with Early Type 2 Diabetic Nephropathy

目的探讨福辛普利联合羟苯磺酸钙治疗老年早期2型糖尿病肾病的疗效。方法选取西安市第九医院肾脏内科2015年1月~2017年4月收治的老年早期2型糖尿病肾病患者100例,随机均分为对照组和观察组,对照组常规降糖基础上加用福辛普利,观察组在对照组基础上加用羟苯磺酸钙。比较两组治疗前后血糖水平、肾脏功能、氧化应激水平及血管内皮功能、生活质量QOL-C30评分及不良反应发生率。结果治疗后,两组血糖水平[空腹血糖(FPG)、餐后2 h血糖(2 hPG)]均显著低于治疗前(P<0.05),组间比较差异无统计学意义(P>0.05);观察组肾脏功能[24 h尿微量白蛋白(mAlb)、β2微球蛋白(β2-MG)、血肌酐(Scr)、尿素氮(BUN)、尿微量白蛋白/肌酐(ACR)]水平均显著低于对照组和治疗前(P<0.05);观察组氧化应激[超氧化物歧化酶(SOD),丙二醛(MDA)]水平均显著优于对照组和治疗前(P<0.05);观察组血管内皮功能[血管性血友病因子(vWF)、内皮素-1(ET-1)]水平均显著低于对照组和治疗前(P<0.05);观察组生活质量量表QOL-C30评分显著高于对照组和治疗前(P<0.05)。结论羟苯磺酸钙联合福辛普利治疗老年早期2型糖尿病肾病可有效改善肾脏功能,降低氧化应激,保护血管内皮细胞功能,提高生活质量,且未增加不良反应风险。

Objective To investigate the effect of fosinopril combined with calcium dobesilate on early type 2 diabetic nephropathy in older patients.Methods 100 older patients with early type 2 diabetic nephropathy were chosen from January 2015 to April 2017 in the Ninth Hospital of Xi’an.The patients were randomly divided into the control group and the observation group.The control group received insulin and fosinopril.The observation group received insulin,fosinopril and calcium dobesilate.The blood glucose level,renal function,oxidative stress level,vascular endothelial function,quality of life questionnaire(QOL-C30)and incidence of adverse reactions were evaluated before and after treatment.Results After treatment,the levels of fasting plasma glucose(FPG)and 2-hour postprandial blood glucose(2hPG)in both groups were significantly lower than those before treatment(P<0.05).There were no significant differences in the levels of FPG and 2hPG between the control group and the observation group(P>0.05).After treatment,the levels of microalbuminuria(mAlb),β2 microglobulin(β2-MG),serum creatinine(Scr),blood urea nitrogen(BUN),and albumin-to-creatine ratio(ACR)in the observation group were significantly lower than those in the control group and before treatment(P<0.05).After treatment,the levels of superoxide dismutase(SOD)and malonaldehyde(MDA)in the observation group were significantly better than those in the control group and before treatment(P<0.05).After treatment,the levels of von willebrand factor(vWF)and endothelin-1(ET-1)in the observation group were significantly lower than those in the control group and before treatment(P<0.05).After treatment,the score of QOL-C30 in the observation group was significantly higher than that in the control group and before treatment(P<0.05).Conclusion Combination of fosinopril and calcium dobesilate might efficiently improve the renal function,reduce the oxidative stress,protect the endothelial cell function,increase the quality of life,and not increase the adverse reactions in the older patients with early type 2 diabetic nephropathy.