阿托伐他汀联合促红素治疗终末期糖尿病肾病维持性血液透析患者临床疗效

Clinical efficacy of atorvastatin combined with erythropoietin in the treatment of end-stage diabetic nephropathy patients w ith maintenance hemodialysis

目的探讨阿托伐他汀与促红素注射液联合治疗终末期糖尿病肾病(DN)维持性血液透析(MHD)患者的临床疗效及对血脂、心功能的影响。方法72例接受MHD治疗的终末期DN患者,采用随机数字表法分为研究组和对照组,每组36例。对照组患者给予促红细胞生成素治疗,研究组患者于对照组的治疗基础上给予阿托伐他汀治疗。比较两组患者治疗前后各项临床指标、营养指标以及心血管不良反应发生情况。结果两组患者均完成本研究治疗过程,无退出或死亡病例。治疗后,两组患者血清胆碱酯酶(CHE)、肌酐(Cr)、谷丙转氨酶(ALT)、血糖(FBG)水平均较治疗前下降,血清白蛋白(ALB)水平及血红蛋白(HGB)水平均较治疗前上升,且研究组患者改善程度优于对照组,差异均具有统计学意义(P<0.05)。治疗后,两组患者体质量指数(BMI)、上臂肌围(MAMC)均高于治疗前,且研究组患者BMI(23.28±0.56)kg/m^2、MAMC(24.81±0.96)cm均高于对照组的(22.85±0.52)kg/m^2、(22.97±0.98)cm,差异均具有统计学意义(P<0.05)。研究组患者血液透析时低血压、心律失常、心绞痛发生率分别为0.77%、0.27%、0.22%,均低于对照组的1.96%、0.87%、0.82%,差异均有统计学意义(P<0.05)。结论对于行MHD治疗的终末期DN患者应用阿托伐他汀治疗,能够更加有效改善肾功能指标和血糖、血脂水平,并降低心血管不良反应的发生率,具有较好的辅助治疗效果。

Objective To discuss the clinical effect of atorvastatin combined with erythropoietin in the treatment of end-stage diabetic nephropathy(DN)patients with maintenance hemodialysis(MHD)and its influence on blood lipid and cardiac function.Methods A total of 72 cases end-stage DN patients receiving MHD therapy were divided into research group and control group by random numerical table,with 36 cases in each group.The control group was treated by erythropoietin,and the research group was treated by atorvastatin orally on the basis of the control group.The clinical indicators,nutritional indicators before and after treatment and occurrence of adverse cardiovascular reactions were compared between the two groups.Results Both groups of patients completed the treatment process of this study,with no withdrawal or death cases.After treatment,the serum cholinesterase(CHE),creatinine(Cr),alanine aminotransferase(ALT),fasting blood glucose(FBG)levels of the two groups was lower than that before treatment,and serum albumin(ALB)and hemoglobin(HGB)level was higher than that before treatment,and the research group had better improvement than the control group.The difference was statistically significant(P<0.05).After treatment,the body mass index(BMI),midarm muscle circumference(MAMC)of the two groups was higher than that before treatment,and BMI(23.28±0.56)kg/m^2,MAMC(24.81±0.96)cm of the research group was higher than that of the control group(22.85±0.52)kg/m^2 and(22.97±0.98)cm,and the difference was statistically significant(P<0.05).The incidence of hypotension,arrhythmia and angina during hemodialysis of the research group was 0.77%,0.27%and 0.22%,which was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Application of atorvastatin to patients with end-stage DN undergoing MHD therapy can more effectively improve renal function indicators,blood glucose and blood lipid levels,and reduce the incidence of cardiovascular adverse reactions,and has a better adjuvant treatment effect.