胰激肽原酶肠溶片联合厄贝沙坦片治疗对2型糖尿病肾病伴高血压患者TM、TNF-α、IL-18的影响

Effect of pancreatic kininogenase enteric-coated tablets combined with irbesartan tablets on TM,TNF-α,IL-18 of type 2 diabetic nephropathy with hypertension

目的观察胰激肽原酶肠溶片联合厄贝沙坦片治疗2型糖尿病肾病伴高血压对患者凝血酶调节蛋白(TM)、肿瘤坏死因子-α(TNF-α)、白细胞介素-18(IL-18)的影响,为临床治疗提供参考。方法回顾性选取2018年3月至2020年3月四川省林业中心医院门诊和住院部收治经诊断为2型糖尿病肾病伴高血压的患者140例,根据是否应用胰激肽原酶肠溶片分为对照组(给予厄贝沙坦片75~150 mg,每日1次)和观察组(胰激肽原酶肠溶片120~240U,每日3次,厄贝沙坦片剂量同对照组),治疗12周。测量2组血糖指标[餐后2 h血糖、空腹血糖、糖化血红蛋白(Hb A1c)]、血压指标[日间和夜间的收缩压、舒张压]的差别,检测2组肾功能指标[血肌酐(Scr)、尿素氮、24 h尿蛋白定量]及血清TM、TNF-α、IL-18、同型半胱氨酸(Hcy)、血管生成素-Ⅰ(Ang-Ⅰ)、血管生成素-Ⅱ(Ang-Ⅱ)等细胞因子的变化,并统计2组临床治疗总有效率和不良反应发生率。结果观察组的总有效率92.86%,高于对照组的80.00%,差异有统计学意义(P<0.05)。治疗前,血糖、血压、肾功能指标及血清因子的差异无统计学意义(P>0.05)。治疗12周后,2组的血清Ang-Ⅰ、Ang-Ⅱ水平较治疗前升高,血糖、血压、肾功能指标及血清TM、TNF-α、IL-18、Hcy等水平均较治疗前降低,差异均有统计学意义(P<0.05),且观察组血清Ang-Ⅰ、Ang-Ⅱ水平高于对照组,血糖、血压、肾功能及血清TM、TNF-α、IL-18、Hcy等水平低于对照组,差异均有统计学意义(P<0.05)。观察组的不良反应发生率为10.00%,与对照组的5.71%比较,差异无统计学意义(P>0.05)。结论胰激肽原酶肠溶片联合厄贝沙坦片治疗2型糖尿病肾病伴高血压可有效控制血压、血糖,调节TM、TNF-α、IL-18等相关因子的表达,改善肾功能,提高疗效。

Objective To observe the effects of trypsin enteric-coated tablets combined with irbesartan tablets on thrombin regulatory protein(TM),tumor necrosis factor-α(TNF-α) and interleukin-18(IL-18) in the treatment of type 2 diabetic nephropathy with hypertension. Methods A retrospective selection of 140 patients diagnosed with type 2 diabetic nephropathy and hypertension in the Departments of Outpatient and Inpatient,Sichuan Forestry Central Hospital from March 2018 to March 2020 were selected according to whether pancreatic kininogenase enteric-coated tablets were used or not. Control group(given irbesartan tablets 75-150 mg,qd) and study group(pancreatic kininogenase enteric-coated tablets 120-240 U,tid,irbesartan tablet doses are the same as the control group),treatment for 12 weeks. The difference of blood glucose index [postprandial 2 h blood glucose,fasting blood glucose,glycosylated hemoglobin(HbA1 c) ],blood pressure index [systolic blood pressure(SBP) and diastolic blood pressure(DBP) ] was measured in two groups,The changes of renal function indexes [serum creatinine,urea nitrogen,24 h urine protein quantification] and serum TM,TNF-α,IL-18,cytokines such as homocysteine(Hcy),angiopoietin-I(Ang-Ⅰ),angiopoietin-II(Ang-Ⅱ) were detected. The total effective rate and incidence of adverse reactions in two groups were analyzed.Results The total effective rate of study group was 92. 86%,which was higher than 80. 00% of the control group,and the difference was statistically significant(P<0.05). Before treatment,there was no significant difference in blood glucose,blood pressure,renal function indexes and serum factors(P>0.05). Serum Ang-Ⅰ,Ang-Ⅱ and other factors increased gradually,blood glucose,blood pressure,renal function index and serum TM,TNF-α,IL-18,Hcy decreased gradually,the differences were statistically significant(P<0.05);The levels of serum Ang-Ⅰ and Ang-Ⅱ in the study group were higher than those in the control group,blood glucose,blood pressure,renal function and serum TM,TNF-α,IL-18,Hcy were lower than those in control group,and the differences were statistically significant(P<0.05);The incidence of adverse reactions in the study group was 10. 00%,which was not statistically different compared with 5. 71% in the control group(P>0.05).Conclusion Pancreatic kininogenase enteric-coated tablets combined with irbesartan tablets in the treatment of type 2 diabetic nephropathy with hypertension can effectively control blood pressure,blood sugar,regulate the expression of TM、TNF-α、IL-18 and other related factors,improve renal function and improve the efficacy.