口服硫酸氨基葡萄糖、硫酸软骨素和双醋瑞因对成人大骨节病患者肾功能的影响

Effect of glucosamine sulfate,chondroitin sulfate and diacetarine on renal function in adult patients with Kashin-Beck disease

目的探讨硫酸氨基葡萄糖、硫酸软骨素和双醋瑞因对成人大骨节病患者尿中肾功指标[尿素(UREA)、肌酐(CREA)、尿微量蛋白(mALB)、N-乙酰-β-D-葡萄糖苷酶(NAG)]的影响。方法根据《大骨节病诊断》标准(WS/T 207-2010),于2019年在黑龙江省大骨节病病区选取Ⅰ度和Ⅱ度成人大骨节病患者,采用临床随机对照试验方法,按照年龄、性别、病情分度等条件采用随机数字表法分为3个治疗组[A组(硫酸氨基葡萄糖组)、B组(硫酸软骨素组)和C组(双醋瑞因组)]。在治疗0、90和180 d时采集患者空腹中段晨尿,使用全自动生化分析仪检测UREA、CREA、mALB及NAG的水平,并分析上述指标异常率。结果治疗0 d,3组分别为118、99、116人;治疗90 d,3组分别剩余115、93、106人;治疗180 d,3组分别剩余95、80、93人。治疗0、180 d时,3组患者UREA、CREA、NAG、mALB水平比较差异均无统计学意义(H=0.055、0.923、0.276、1.125,1.635、3.873、1.045、4.135,P均>0.05)。治疗90 d时,3组患者CREA水平比较差异无统计学意义(H=1.719,P>0.05),C组患者UREA、NAG水平均高于B组(P均<0.05),B组患者mALB水平高于C组(P<0.05)。治疗90 d时,3组患者mALB水平均低于0 d(Z=-2.858、-3.217、-2.124,P均<0.05),NAG水平均高于0 d(Z=-3.700、-2.222、-4.672,P均<0.05),C组患者UREA水平高于0 d(Z=-2.393,P<0.05)。治疗180 d时,3组患者CREA水平均高于0 d(Z=-5.853、-6.984、-6.255,P均<0.05),3组患者mALB水平均低于0 d(Z=-3.785、-2.624、-3.427,P均<0.05)。治疗180 d时,3组患者CREA异常率均高于治疗0、90 d(χ^(2)=39.499、37.707,71.534、57.959,58.160、55.129,P均<0.05),治疗0 d与治疗90 d的CREA异常率比较差异均无统计学意义(χ^(2)=0.004、2.068、0.053,P均>0.05)。A、C两组患者治疗90 d的NAG异常率均高于治疗0 d(χ^(2)=8.999、11.227,P均<0.05)。C组患者治疗180 d的NAG异常率高于治疗0 d(χ^(2)=5.006,P<0.05)。A、C两组患者治疗90 d的NAG异常率与治疗180 d比较差异均无统计学意义(χ^(2)=1.976、1.413,P均>0.05)。A、B两组患者治疗90 d和治疗180 d的mALB异常率均低于治疗0 d(χ^(2)=6.461、8.881,7.563、4.999,P均<0.05),治疗90 d与治疗180 d比较差异均无统计学意义(χ^(2)=0.638、0.013,P均>0.05)。结论服用180 d硫酸氨基葡萄糖、复方硫酸软骨素及双醋瑞因对患者肾功的影响无显著差异,但3种药物均对CREA、NAG有一定影响,在药物治疗时要做好人群随访工作,密切监视这两项指标变化情况。

Objective To investigate the effects of glucosamine sulfate,chondroitin sulfate and diacetarine on urinary renal function indexes UREA,creatinine(CREA),urinary microprotein(mALB)and N-acetyl-β-D-glucosidase(NAG)in adult patients with Kashin-Beck disease.Methods According to the criteria of"Diagnosis of Kashin-Beck Disease"(WS/T 207-2010),adult patients with degreesⅠandⅡKashin-Beck disease in Heilongjiang Province were selected in 2019.They were randomly divided into three treatment groups according to age,gender,disease classification and other condition by clinical randomized controlled trial,group A(glucosamine sulfate group),group B(chondroitin sulfate group)and group C(diacetarine group).Fasting mid-morning urine was collected at 0,90 and 180 days of treatment.The levels of UREA,CREA,mALB and NAG were measured using an automatic biochemical analyzer.And the abnormal rates of the above indexes were analyzed.Results At 0 day of treatment,there were 118,99 and 116 people in the 3 groups,respectively;after 90 days of treatment,115,93 and 106 people remained in the 3 groups;after 180 days of treatment,95,80 and 93 people remained in the 3 groups.The results showed that there was no significant difference in the levels of UREA,CREA,NAG and mALB among the 3 groups at 0 and 180 days of treatment(H=0.055,0.923,0.276,1.125,1.635,3.873,1.045,4.135,P>0.05).After 90 days of treatment,there was no significant difference in CREA level among the 3 groups(H=1.719,P>0.05),the levels of UREA and NAG in group C were higher than those in group B(P<0.05),and the level of mALB in group B was higher than that in group C(P<0.05).The comparison results of all indexes before and after treatment showed that after 90 days of treatment,the levels of mALB in the 3 groups were lower than those of 0 day(Z=-2.858,-3.217,-2.124,P<0.05),the levels of NAG were higher than those of 0 day(Z=-3.700,-2.222,-4.672,P<0.05);and the level of UREA in group C was higher than that of 0 day(Z=-2.393,P<0.05).After 180 days of treatment,the levels of CREA in the 3 groups were higher than those of 0 day(Z=-5.853,-6.984,-6.255,P<0.05),and the levels of mALB in the 3 groups were lower than those of 0 day(Z=-3.785,-2.624,-3.427,P<0.05).The abnormal rates of CREA in the 3 groups after 180 days of treatment were higher than those of 0 and 90 days(χ^(2)=39.499,37.707,71.534,57.959,58.160,55.129,P<0.05).There was no significant difference in the abnormal rate of CREA between 0 day and 90 days of treatment(χ^(2)=0.004,2.068,0.053,P>0.05).The abnormal rates of NAG in groups A and C after 90 days of treatment were higher than those of 0 day(χ^(2)=8.999,11.227,P<0.05).The abnormal rates of NAG in group C after 180 days of treatment was higher than that of 0 day(χ^(2)=5.006,P<0.05).There was no significant difference in the abnormal rate of NAG between group A and group C after 90 days and 180 days of treatment(χ^(2)=1.976,1.413,P>0.05).The abnormal rates of mALB in groups A and B after 90 days and 180 days of treatment were lower than those of 0 day(χ^(2)=6.461,8.881,7.563,4.999,P<0.05),and there was no significant difference between 90 days of treatment and 180 days of treatment(χ^(2)=0.638,0.013,P>0.05).Conclusions The effects of glucosamine sulfate,compound chondroitin sulfate and diacetarine on renal function of the patients are not significantly different after 180 days of medication,but the three drugs all have certain effects on CREA and NAG.Follow-up work should be done during drug treatment to closely monitor the changes of the two indicators.