舒洛地特联合缬沙坦治疗糖尿病肾病的疗效及对患者肾保护作用和糖脂代谢的影响

Curative effect of sulodexide combined with valsartan in the treatment of diabetic nephropathy and its effect on renal protection and glucose and lipid metabolism of the patients

目的探讨舒洛地特联合缬沙坦治疗糖尿病肾病(DN)的疗效及对患者肾保护作用和糖脂代谢的影响。方法选取2019年12月至2020年12月宝鸡市中心医院收治的98例DN患者作为研究对象,按随机数表法分为观察组和对照组,每组49例。对照组患者予以缬沙坦治疗,观察组患者予以舒洛地特联合缬沙坦治疗,疗程12周。治疗12周后,比较两组患者的临床疗效,以及治疗前后的肾功能指标、糖脂代谢指标、血管内皮功能;治疗结束时,记录两组患者的药物不良反应发生情况。结果观察组患者的治疗总有效率为93.88%,明显高于对照组的79.59%,差异有统计学意义(P<0.05);治疗后,两组患者的24 h尿蛋白、尿素氮(BUN)、血肌酐(Scr)水平均降低,且观察组的上述各项指标分别为(1.51±0.33)g、(4.22±0.96)mmol/L、(65.84±8.65)μmol/L,明显低于对照组的(2.29±0.52)g、(5.19±1.12)mmol/L、(80.42±11.09)μmol/L,差异均具有统计学意义(P<0.05);治疗后,两组患者的糖化血红蛋白(HbA1c)、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)均降低,且观察组的上述各项指标分别为(7.68±1.01)%、(7.16±1.05)mmol/L、(1.95±0.51)mmol/L、(4.46±0.83)mmol/L,明显低于对照组的(8.75±1.34)%、(7.98±1.13)mmol/L、(3.28±0.84)mmol/L、(5.42±0.91)mmol/L,差异均有统计学意义(P<0.05);治疗后,两组患者的血清内皮素-1(ET-1)水平均降低,且观察组为(60.82±7.34)ng/L,明显低于对照组的(71.72±8.92)ng/L,差异均具有统计学意义(P<0.05);治疗后,两组患者的血清一氧化氮(NO)水平升高,且观察组为(68.93±10.69)μmol/L,明显高于对照组的(59.24±8.34)μmol/L,差异均有统计学意义(P<0.05);观察组患者治疗期间的不良反应总发生率为12.24%,略高于对照组的8.16%,但差异无统计学意义(P>0.05)。结论舒洛地特联合缬沙坦治疗可以提高DN患者的临床疗效,发挥肾保护作用,调节糖脂代谢,改善血管内皮功能,且不会增加不良反应,安全性高。

Objective To explore the curative effect of sulodexide combined with valsartan in the treatment of diabetic nephropathy(DN)and its effect on renal protection and glucose and lipid metabolism of the patients.Methods A total of 98 patients with DN admitted to Baoji Central Hospital from December 2019 and December 2020 were enrolled as the research objects.They were divided into an observation group(n=49)and a control group(n=49)by random number table method.The patients in control group were treated with valsartan,while the patients in observation group were treated with sulodexide combined with valsartan,for 12 weeks.After treatment,the clinical curative effect,renal function indexes,glucose-lipid metabolism indexes,and vascular endothelial function before and after treatment were compared between the two groups.At the end of treatment,occurrence of adverse drug reactions in both groups was recorded.Results The total effective rate of treatment in the observation group was 93.88%,which was significantly higher than 79.59%in the control group(P<0.05).After treatment,the levels of 24 h urine protein,blood urea nitrogen(BUN),and serum creatinine(Scr)in both groups were decreased,and the above indexes in the observation group were(1.51±0.33)g,(4.22±0.96)mmol/L,and(65.84±8.65)μmol/L,respectively,which were significantly lower than(2.29±0.52)g,(5.19±1.12)mmol/L,and(80.42±11.09)μmol/L in the control group(P<0.05).After treatment,the levels of glycosylated hemoglobin(Hb A1c),fasting blood glucose(FPG),triglyceride(TG),and total cholesterol(TC)in both groups were decreased,and the above indexes in the observation group were(7.68±1.01)%,(7.16±1.05)mmol/L,(1.95±0.51)mmol/L,(4.46±0.83)mmol/L,respectively,which were significantly lower than(8.75±1.34)%,(7.98±1.13)mmol/L,(3.28±0.84)mmol/L,(5.42±0.91)mmol/L in the control group(P<0.05).After treatment,the level of serum endothelin-1(ET-1)in both groups was decreased,and the level in the observation group was(60.82±7.34)ng/L,which was significantly lower than(71.72±8.92)ng/L in the control group(P<0.05).After treatment,the level of nitric oxide(NO)in both groups was increased,and the level in the observation group was(68.93±10.69)μmol/L,which was significantly higher than(59.24±8.34)μmol/L in the control group(P<0.05).The total incidence of adverse reactions during treatment in the observation group was 12.24%,slightly higher than 8.16%in the control group,but the difference was not statistically significant(P>0.05).Conclusion Sulodexide combined with valsartan can improve clinical curative effect in the treatment of DN patients,exert renal protection effect,regulate glucose-lipid metabolism,improve vascular endothelial function,and will not increase adverse reactions,with high safety.