小剂量螺内酯联合RAAS阻断剂治疗早期糖尿病肾病的效果分析

Analysis of the Effect of Low-dose Spironolactone Combined with RAAS Blocker in the Treatment of Early Diabetic Nephropathy

目的探究小剂量螺内酯联合肾素-血管紧张素-醛固酮系统(RAAS)阻断剂治疗早期糖尿病肾病(DN)的临床疗效。方法选取2020年3月—2021年3月医院收治的早期DN患者60例,采用随机数字表法分为对照组和观察组,各30例。其中对照组采用RAAS阻断剂(厄贝沙坦)治疗,观察组在对照组的基础上增加小剂量螺内酯治疗,对比两组血糖、肾功能指标、血脂水平变化。结果治疗后,两组患者血糖指标空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)水平及肾功能指标血肌酐(Scr)、尿素氮(BUN)、β_(2)-微球蛋白(β_(2)-MG)、尿白蛋白排泄率(UAER)水平均较治疗前明显降低,差异有统计学意义(P<0.05);观察组血糖及肾功能各项指标水平均较对照组改善更佳,差异有统计学意义(P<0.05);治疗后,两组患者血清高密度脂蛋白胆固醇(HDL-C)指标水平均较治疗前升高,血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平指标均较治疗前明显降低,且观察组血脂各项指标水平较对照组改善更优,差异有统计学意义(P<0.05);两组不良反应发生率对比,差异无统计学意义(P>0.05)。结论小剂量螺内酯联合RAAS阻断剂可有效缓解早期DN症状,改善血糖、血脂水平,保护肾脏功能,进而延缓或控制疾病进展,应用价值较高。

Objective To explore the clinical efficacy of low-dose spironolactone combined with renin-angiotensinaldosterone system(RAAS) blocker in the treatment of early diabetic nephropathy(DN). Methods From March 2020 to March 2021, 60 patients with early-stage DN were selected and divided into control group and observation group by random number table method, 30 cases in each group. The control group was treated with RAAS blocker(irbesartan) treatment, the observation group added low-dose spironolactone treatment on the basis of the control group, and compared the changes in blood glucose, renal function indicators, and blood lipid levels between the two groups. Results After treatment, the two groups of patients’ blood glucose indicators fasting blood glucose(FPG), 2 h postprandial blood glucose(2 hPG), glycosylated hemoglobin(HbA1c) levels and renal function indicators blood creatinine(Scr), urea nitrogen(BUN), β_(2)-microglobulin(β_(2)-MG) and urinary albumin excretion rate(UAER) were significantly lower than before treatment, the difference was statistically significant(P<0.05). The blood glucose and renal function indexes of the observation group improved better than those of the control group, the difference was statistically significant(P<0.05). After treatment, the levels of serum high-density lipoprotein cholesterol(HDL-C) of the two groups of patients were higher than before treatment, and serum total cholesterol(TC), triacylglycerol(TG), and lowdensity lipoprotein cholesterol(LDL-C), were significantly lower than those before treatment, and the levels of blood lipids in the observation group were better than those in the control group, the difference was statistically significant(P <0.05). Comparison of adverse reactions rates between the two groups, the difference was not statistically significant(P>0.05). Conclusion Low-dose spironolactone combined with RAAS blockers can effectively alleviate the symptoms of early DN, improve blood glucose and blood lipid levels, protect kidney function, and delay or control disease progression. It has high application value.