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恩格列净联合厄贝沙坦治疗非肾病综合征型膜性肾病的临床疗效

Clinical efficacy of empagliflozin combined with irbesartan in the treatment of non-nephrotic membranous nephropathy
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摘要 目的观察恩格列净联合厄贝沙坦治疗非肾病综合征型膜性肾病(MN)的临床疗效。方法选取2022年11月—2024年1月湖南省人民医院收治的MN患者118例,遵循随机分组对照试验原则分为观察组和对照组,每组59例。对照组予厄贝沙坦片治疗,观察组在对照组基础上予恩格列净片治疗。2组均治疗6个月后比较疗效,治疗前后肾功能指标[血清胱抑素C、24 h尿蛋白定量(UTP)、血肌酐、尿素氮]、相关生化指标[血尿酸(UA)、尿白蛋白肌酐比(UACR)、血清β2微球蛋白(β2-MG)、血清白蛋白(Alb)]、血清细胞因子[血管内皮生长因子(VEGF)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)、白介素-8(IL-8)、白介素-31(IL-31)]、血脂指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平变化,以及不良反应。结果观察组患者治疗总有效率为98.31%,高于对照组的79.66%(χ^(2)=10.460,P=0.001);治疗6个月后,2组胱抑素C、UTP、血肌酐、尿素氮、UA、UACR、β2-MG、VEGF、TNF-α、TGF-β、IL-8、IL-31、TC、TG、LDL-C水平均较治疗前下降,Alb、HDL-C水平升高,且观察组低/高于对照组,组间差异均有统计学意义(P<0.05或P<0.01);观察组与对照组不良反应总发生率比较差异无统计学意义(5.08%vs.1.69%,P Fisher=0.619)。结论恩格列净结合厄贝沙坦治疗MN的临床疗效理想,能够进一步改善患者肾功能与临床相关生化指标,拮抗炎性反应,促进患者肾小球内皮损伤修复,调节血脂代谢水平,减少患者的蛋白流失。 Objective To observe the clinical efficacy of empagliflozin combined with irbesartan in treating non-nephrotic membranous nephropathy.Methods One hundred and eighteen patients with membranous nephropathy admitted to Hunan Provincial People′s Hospital between November 2022 and January 2024 were randomly assigned to either the observation group or the control group,with 59 patients in each group.Patients in the control group were treated with irbesartan tablets,whereas those in the observation group received both irbesartan and empagliflozin tablets.After 6 months of treatment,the clinical outcomes,changes in renal function indicators(serum cystatin C,UTP,serum creatinine,blood urea nitrogen),related biochemical indicators(UA,UACR,β2-MG,Alb),serum cytokines(VEGF,TNF-α,TGF-β,IL-8,IL-31),and lipid profiles(TC,TG,LDL-C,HDL-C),as well as adverse events,were compared between the two groups.Results The overall effective rate was significantly higher in the observation group(98.31%)compared with the control group(79.66%)(χ^(2)=10.460,P=0.001).Compared with baseline,the levels of cystatin C,UTP,serum creatinine,blood urea nitrogen,UA,UACR,β2-MG,VEGF,TNF-α,TGF-β,IL-8,IL-31,TC and TG decreased significantly in both groups after 6 months of treatment,while Alb and HDL-C levels increased.These changes were more pronounced in the observation group compared with the control group,and the differences between the two groups were statistically significant(P<0.05 or P<0.01).The overall incidence of adverse events was 5.08%in the observation group and 1.69%in the control group,and the difference was not statistically significant(P Fisher=0.619).Conclusion The combined use of empagliflozin and irbesartan showed significant clinical benefits in patients with non-nephrotic membranous nephropathy.By improving renal function,reducing proteinuria,and modulating various biochemical and inflammatory parameters,this combination therapy holds promise for the management of this disease.
作者 肖争 吴余燕 XIAO Zheng;WU Yuyan(Department of Nephrology,Hunan Provincial People′s Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China;不详)
出处 《临床合理用药杂志》 2024年第34期16-20,共5页 Chinese Journal of Clinical Rational Drug Use
基金 湖南省自然科学基金项目(2023JJ40376)。
关键词 膜性肾病 非肾病综合征型 恩格列净 厄贝沙坦 肾功能 血清细胞因子 Membranous nephropathy,non nephrotic syndrome type Empagliflozin Irbesartan Renal function Serum cytokines
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