替米沙坦联合骨化三醇治疗早期糖尿病肾病患者临床效果及对血清Lp(α)、TGF-β1水平影响

Clinical Effects of Telmisartan Combined with Calcitriol in the Treatment of Patients with Early Diabetic Nephropathy and Its Influence on Serum Lp(α)and Transforming Growth Factor-β1 Levels

目的探讨替米沙坦联合骨化三醇治疗早期糖尿病肾病(diabetic nephropathies,DN)患者临床效果及对血清脂蛋白α[Lp(α)]、TGF-β1水平影响。方法选取符合纳入及排除标准的早期DN 96例,根据治疗方法不同将其分为观察组(51例)和对照组(45例)两组。观察组给予替米沙坦联合骨化三醇治疗,对照组给予替米沙坦治疗,均连续治疗3个月。观察比较两组治疗后临床效果,治疗前后空腹血糖(FPG)、糖化血红蛋白(HbA1c)、24 h尿蛋白定量(24 h UTP)、肾功能指标[血肌酐(Scr)、血尿素(BUN)、肾小球滤过率(eGFR)]和血清Lp(α)、TGF-β1水平,以及治疗期间不良反应发生情况。结果治疗后,观察组总有效率为86.27%高于对照组总有效率66.67%,差异有统计学意义(P<0.05)。治疗后,两组FPG、HbA1c、24 h UTP、Scr、BUN和血清Lp(α)、TGF-β1水平较治疗前降低,eGFR较治疗前升高,差异有统计学意义(P<0.05或P<0.01)。治疗后,观察组FPG、HbA1c、24 h UTP、Scr、BUN和血清Lp(α)、TGF-β1水平低于对照组,eGFR高于对照组,差异有统计学意义(P<0.05或P<0.01)。治疗期间,总不良反应发生率观察组17.65%高于对照组11.11%,但两组比较差异无统计学意义(P>0.05)。结论替米沙坦联合骨化三醇治疗早期DN患者效果良好,可降低血糖、尿蛋白及血清Lp(α)、TGF-β1水平,改善肾功能,且安全性良好。

Objective To explore the clinical effects of Telmisartan combined with Calcitriol in the treatment of patients with early diabetic nephropathy(DN)and its influence on serum lipoproteinα[Lp(α)]and transforming growth factor-β1(TGF-β1)levels.Methods A total of 96 patients with early DN meeting the inclusion and exclusion criteria were selected and divided into observation group(n=51)and control group(n=45)according to different treatment methods.The observation group was treated with Telmisartan and Calcitriol,while the control group was treated with Telmisartan,and both groups received 3 months of continuous treatment.The clinical effects,levels of fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),24 h urine protein quantification(24 h UTP),renal function indexes[serum creatinine(Scr),blood urea nitrogen(BUN),glomerular filtration rate(eGFR)],serum Lp(α)and TGF-β1 before and after treatment,as well as the incidence of adverse reactions during treatment were compared between the two groups.Results The total response rate of observation group was higher than that of control group(86.27%vs.66.67%)(P<0.05).After treatment,the levels of FPG,HbA1c,24 h UTP,Scr,BUN,serum Lp(α)and TGF-β1 were decreased,while eGFR was increased in the two groups(P<0.05 or P<0.01).The levels of FPG,HbA1c,24 h UTP,Scr,BUN,serum Lp(α)and TGF-β1 in observation group were lower than those in the control group,and eGFR was higher than that in the control group(P<0.05 or P<0.01).During treatment,the total incidence of adverse reactions in the observation group was 17.65%,which was higher than 11.11%in the control group,but there were no significant differences between the two groups(P>0.05).Conclusion Telmisartan combined with Calcitriol is effective in the treatment of early DN,which can lower blood glucose,urine protein,serum Lp(α)and TGF-β1 levels,and improve renal function,with good safety.