羟苯磺酸钙联合硫辛酸对糖尿病合并肾损伤患者糖脂代谢及肾功能的影响

Effects of calcium dobesilate combined with thioctic acid on glucose and lipid metabolism and renal function in diabetic nephropathy patients

目的研究羟苯磺酸钙联合硫辛酸对糖尿病合并肾损伤(DN)患者糖脂代谢及肾功能的影响。方法按照就诊序号,将132例DN患者均分为A组(硫辛酸治疗)与B组(羟苯磺酸钙联合硫辛酸治疗),比较2种治疗方案对患者糖脂代谢及肾功能的影响。结果治疗后,2组患者空腹血糖(FPG)、餐后2 h血糖(p2 hPG)及糖化血红蛋白(HbA1c)水平与治疗前比较无显著性变化,治疗后2组FPG、p2 hPG及HbA1c水平组间比较差异无统计学意义(P>0.05);治疗后,2组总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平与治疗前相比,均未发生显著性变化,治疗后2组TC、TG、HDL-C及LDL-C水平比较差异无统计学意义(P>0.05);治疗后,2组血肌酐(Cr)、24 h尿白蛋白排泄量(UAE)及尿素氮(BUN)水平较同组治疗前显著下降(P<0.05),且B组患者治疗后Cr和UAE水平均显著低于A组(P<0.05),2组治疗后BUN水平比较差异无统计学意义(P>0.05);治疗后,A组血清内皮素(ET)、血清一氧化氮(NO)及血浆纤溶酶原激活剂抑制物-1(PAI-1)水平与治疗前比较差异无统计学意义(P>0.05),B组血清ET水平均较同组治疗前显著下降(P<0.05),血清NO及血浆PAI-1水平均较同组治疗前显著上升(P<0.05),B组患者治疗后血清ET水平显著低于A组(P<0.05),血清NO及血浆PAI-1水平显著高于A组(P<0.05);治疗后2组血清胱抑素-C(CysC)及尿N-乙酰-β-D-氨基葡糖苷酶(NAG)水平均较同组治疗前显著下降(P<0.05),且B组血清CysC及尿NAG水平显著低于A组(P<0.05)。结论羟苯磺酸钙联合硫辛酸治疗DN的效果优于单用硫辛酸,羟苯磺酸钙可能通过改善患者血管内皮细胞功能发挥肾脏保护作用。

Objective To investigate the effects of calcium dobesilate combined with thioctic acid on glucose and lipid metabolism and renal function in patients with diabetic nephropathy(DN).Methods According to admission order,132 DN patients were divided into 2 groups according to group A(thioctic acid)and group B(calcium dobesilate combined with thioctic acid).Then the effect of the 2 treatment methods on glucose and lipid metabolism and renal function were compared.Results The levels of fasting plasma glucose(FPG),postprandial 2 h plasma glucose(p2 hPG)and glycosylated hemoglobin(HbA1c)after treatment showed no significant changes with those before treatment,and the post-treatment FPG,p2 hPG and HbA1c levels had no statistic difference between the groups(P>0.05).After treatment,the levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)had no significant changes in both groups,and the post-treatment TC,TG,HDL-C and LDL-C showed no statistic difference between the groups(P>0.05).After treatment,the levels of serum creatinine(Cr),24 h urinary albumin excretion(UAE)and blood urea nitrogen(BUN)were decreased in both groups(P<0.05).The levels of Cr and UAE in group B were significantly lower than those in group A(P<0.05),and no significant difference was found in BUN levels between groups after treatment(P>0.05).The levels of serum endothelin(ET),serum nitric oxide(NO)and plasma plasminogen activator inhibitor-1(PAI-1)in group A had no significant difference before and after treatment(P>0.05).In group B,the serum ET level was decreased,and serum NO and plasma PAI-1 levels were increased after treatment(P<0.05).Compared with group A,group B had lower ET level as well as higher serum NO and plasma PAI-1 levels after treatment(P<0.05).After treatment,the levels of serum cystatin-C(CysC)and urine N-acetyl-β-D-glucosaminidase(NAG)were decreased in both groups,and were lower in group B than in group A(P<0.05).Conclusion Calcium dobesilate combined with lipoic acid is better than lipoic acid alone in the treatment of DN,calcium dobesilate may play a renal protective role by improving the function of vascular endothelial cells.