沙库巴曲缬沙坦钠片联合恩格列净对糖尿病肾病合并高血压病患者肾血流动力学及血清凝血酶调节蛋白水平的影响

Impacts of sacubitril/valsartan sodium table combined with empagliflozin on renal hemodynamics and serum thrombomodulin level in patients with diabetes nephropathy and hypertension

目的探讨沙库巴曲缬沙坦钠片联合恩格列净对糖尿病肾病合并高血压病患者肾血流动力学及血清凝血酶调节蛋白水平的影响。方法选择2020年6月至2022年7月河北省沧州市中心医院收治的158例糖尿病肾病合并高血压病患者为研究对象,按照随机数字表法将患者分为联合治疗组和恩格列净组,各79例。恩格列净组在常规治疗基础上口服恩格列净治疗;联合治疗组在恩格列净组基础上给予沙库巴曲缬沙坦钠片治疗。2组均持续治疗6个月。比较2组治疗前后血糖、血压指标、体质量、肾血流动力学指标、肾功能指标及凝血酶调节蛋白水平。比较2组临床疗效及不良反应发生情况。结果治疗后,2组收缩压、舒张压、空腹血糖、餐后2 h血糖、糖化血红蛋白、体质量、全血高切黏度、全血低切黏度、纤维蛋白原、血小板聚集率、血肌酐、血尿素氮、尿蛋白排泄率、凝血酶调节蛋白水平均低于治疗前,估算肾小球滤过率均高于治疗前,且联合治疗组变化均优于恩格列净组(均P<0.05)。联合治疗组总有效率高于恩格列净组[96.2%(76/79)比82.3%(65/79)],差异有统计学意义(P=0.005)。联合治疗组总不良反应发生率低于恩格列净组[5.1%(4/79)比7.6%(6/79)],但差异无统计学意义(P=0.513)。结论沙库巴曲缬沙坦钠片联合恩格列净可降低糖尿病肾病合并高血压病患者血糖、血压、血清凝血酶调节蛋白水平,减轻肾功能损伤,改善肾血流动力学,提高临床疗效。

Objective To analyze the impacts of sacubitril/valsartan sodium table combined with empagliflozin on renal hemodynamics and serum thrombomodulin levels in patients with diabetes nephropathy and hypertension.Methods From June 2020 to July 2022,158 patients with diabetes nephropathy and hypertension admitted to Cangzhou Central Hospital,Hebei Province were regarded as the study subjects,and they were grouped into combined treatment group and empagliflozin group,with 79 cases in each group.Empagliflozin group was treated with empagliflozin orally based on conventional treatment,and combined treatment group was treated with sacubitril/valsartan sodium table based on empagliflozin group.Both groups were treated for 6 months.The blood glucose,blood pressure indicators,body mass,renal hemodynamic indicators,renal function indicators,and thrombin regulatory protein levels between the two groups before and after treatment were compared.The clinical efficacy and adverse reactions of two groups were recorded.Results After treatment,the levels of systolic blood pressure,diastolic blood pressure,fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin,body mass,whole blood high shear viscosity,whole blood low shear viscosity,fibrinogen,platelet aggregation rate,serum creatinine,blood urea nitrogen,urinary protein excretion rate,thrombomodulin of two groups were all lower than those before treatment,the level of estimated glomerular filtration rate of two groups was higher than that before treatment,and the combined treatment group was better than the empagliflozin group(all P<0.05).The total effective rate of the combined treatment group was higher than that of the empagliflozin group[96.2%(76/79)vs 82.3%(65/79)](P=0.005).The total incidence of adverse reactions of the combined treatment group was lower than that of the empagliflozin group[5.1%(4/79)vs 7.6%(6/79)],but there was no statistically significant difference(P=0.513).Conclusions Sacubitril/valsartan sodium table combined with empagliflozin can reduce blood glucose,blood pressure,and serum thrombomodulin levels in patients with diabetes nephropathy and hypertension,reduce renal function damage,improve renal hemodynamics,and improve the therapeutic effect.