降低尿蛋白药物治疗糖尿病肾病患者的临床效果评价

Clinical Effect Evaluation of the Effectiveness of Drugs to Reduce Urinary Protein in Patients with Diabetic Nephropathy

目的:通过考察早期糖尿病肾病(DN)患者住院期间、随访6个月和12个月的尿蛋白水平降低情况,评价降低尿蛋白药物的疗效,并探索可能影响药物疗效的因素,为患者用药及医保政策制定提供参考。方法:本文通过检测患者住院期间、随访6个月和12个月时的尿蛋白水平,记录所有患者的一般情况(性别、年龄、吸烟史、饮酒史、高血压病史)、检验结果(糖化血红蛋白、肌酐)及用药情况(降糖方案、改善微循环及降低尿蛋白药物),运用二元Logistic回归分析法探究影响临床治疗有效性的因素。结果:患者住院期间,显著影响尿微量白蛋白治疗有效性的因素包括患者病程(OR=0.522,95%CI=0.304~0.896,P=0.018)、糖化血红蛋白(OR=0.604,95%CI=0.364~1.000,P=0.050)、肌酐清除率(OR=1.899,95%CI=1.141~3.159,P=0.014)、服用金水宝胶囊(OR=3.686,95%CI=1.351~10.060,P=0.011);随访6个月时,患者用药后均未发现显著降低尿蛋白作用;随访12个月时,患者服用血管紧张素转化酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)类药物(OR=5.751,95%CI=1.443~22.914,P=0.013)可显著降低尿蛋白水平。结论:住院期间,早期DN患者可短期服用金水宝胶囊进行降尿蛋白治疗。但随着病程延长、血糖水平控制不佳及肌酐清除率降低,临床治疗有效性可能下降,因此不建议患者长期服用金水宝胶囊进行降低尿蛋白治疗。如果患者可耐受,建议长期服用ACEI或ARB类药物降低尿蛋白。

Objective:To observe the decrease of urinary protein in patients with early diabetic nephropathy(DN)during hospitalization and follow-up for 6 months and 12 months,to evaluate the effectiveness of drugs to reduce urinary protein and to explore the factors which may affect the efficacy of drugs,in order to provide references for patients’medication and medical insurance policy.Methods:In this study,the urinary protein levels of all patients were measured during hospitalization and follow-up for 6 months and 12 months.The general situation(gender,age,smoking history,drinking history,hypertension history)of all patients,the test results(hemoglobin Alc,creatinine)and medication(hypoglycemic program,microcirculation improvement and proteinuria lowering drugs)were recorded.Binary Logistic regression analysis was used to analyze the factors affecting the effectiveness of clinical treatment.Results:During hospitalization,the factors that significantly affected the effectiveness of urinary microalbumin treatment included the course of disease(OR=0.522,95%CI=0.304~0.896,P=0.018),glycosylated hemoglobin(OR=0.604,95%CI=0.364~1.000,P=0.050),creatinine clearance rate(OR=1.899,95%CI=1.141~3.159,P=0.014)and use of Jinshuibao capsule(OR=3.686,95%CI=1.351~10.060,P=0.011).During the follow-up of 6 months,it was not found that there was significant decrease in urinary protein.At the follow-up of 12 months,angiotensin converting enzyme inhibitors(ACEI)or angiotensinⅡreceptor blockers(ARB)drugs taken by patients significantly reduced urinary protein levels(OR=5.751,95%CI=1.443~22.914,P=0.013).Conclusion:During hospitalization,Jinshuibao capsule can be given to the patients with early diabetic kidney disease for a short time.However,with the prolongation of the course of disease,the poor control of blood glucose level and the decrease of creatinine clearance rate,the effectiveness of the clinic treatment may decrease.Therefore,it is not recommended to use Jinshuibao capsule for long-term uroprotein-lowering therapy.If patients can tolerate it,it is recommended to take ACEI or ARB drugs for a long time to reduce urinary protein treatment.