钙离子拮抗剂联合厄贝沙坦对老年2型糖尿病肾病患者尿微量清蛋白的影响

Effect of Calcium Ion Antagonist Combined with Irbesartan on Microalbuminuria in Elderly Patients with Type 2 Diabetic Nephropathy

目的探讨钙离子拮抗剂联合厄贝沙坦治疗老年2型糖尿病肾病的效果及对患者尿微量清蛋白的影响。方法选择2013年2月至2016年4月粤北医院收治的80例老年2型糖尿病肾病患者作为研究对象,按随机数字表法分为对照组与观察组各40例,对照组单用厄贝沙坦治疗,观察组加用钙离子拮抗剂硝苯地平缓释片治疗,比较两组治疗效果,测定两组治疗前后血肌酐(Scr)、血尿素氮(BUN)、血肌酐清除率(Ccr)、24 h尿总蛋白(24 h UP)、尿清蛋白排泄率(UAER)等肾功能指标的改善情况,检测患者治疗前后空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)等血糖指标的差异,测定两组治疗前后甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇水平(HDL-C)的变化。结果①观察组临床治疗有效率高于对照组(92.50%vs 72.50%),差异具有统计学意义(P<0.05);②治疗后,两组24 h UP、UAER、Scr均降低,与同组治疗前比较差异有统计学意义(P<0.05),观察组治疗后24 h UP、UAER均低于对照组[(0.11±0.05)g/24 h、(61.42±9.56)μg/min vs(0.18±0.04)g/24 h、(73.51±8.97)μg/min](P<0.05);③治疗前,两组FBG、2hPG、HbA1c比较差异无统计学意义(P>0.05),治疗后,两组上述指标均降低,与治疗前比较差异有统计学意义(P<0.05);④治疗后,观察组TC、TG、LDL-C均降低,与同组治疗前[(4.81±0.65)mmol/L、(1.51±0.26)mmol/L、(3.63±0.22)mmol/L vs(6.51±0.51)mmol/L、(2.54±0.46)mmol/L、(4.07±0.36)mmol/L]及对照组治疗后[(4.81±0.65)mmol/L、(1.51±0.26)mmol/L、(3.63±0.22)mmol/L vs(6.51±0.43)mmol/L、(2.44±0.29)mmol/L、(4.05±0.45)mmol/L]对比差异均有统计学意义(P<0.05)。结论在老年2型糖尿病肾病患者的临床治疗中,采用钙离子拮抗剂硝苯地平缓释剂联合血管紧张素受体抑制剂厄贝沙坦治疗方案,临床效果肯定,可明显下调患者尿微量清蛋白排泄率,保护其肾功能。

Objective To investigate the effect of calcium ion antagonist combined with irbesartan on microalbuminuria in elderly patients with type 2 diabetic nephropathy.Methods 80 cases of elderly patients with type 2 diabetic nephropathy treated in the hospital from February 2013 to April 2016 were enrolled in the study.By random number table method,they were divided into the control group and the observation group,40 cases in each group.The control group were treated with irbesartan,and the observation group were additionally treated with calcium ion antagonist nifedipine sustained-release tablets.The therapeutic effects were compared between the two groups.The improvement of renal function indexes such as serum creatinine(Scr),blood urea nitrogen(BUN),creatinine clearance rate(Ccr),24 h urinary protein(24 h UP)and urinary albumin excretion rate(UAER)was determined.The blood glucose indexes such as fasting blood glucose(FBG),postprandial 2 h blood glucose(2 hPG)and glycosylated hemoglobin(Hb A1 c)were detected before and after treatment.The changes of triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)levels in the two groups before and after treatment were determined.Results①The clinical effective rate of treatment in the observation group was higher than that in the control group(92.50%vs 72.50%)(P<0.05).②After the treatment,24 h UP,UAER and Scr in the two groups were decreased.Compared with the same group before treatment,there were statistically significant differences(P<0.05).After treatment,24 h UP and UAER in the observation group were lower than those in the control group[(0.11±0.05)g/24 h,(61.42±9.56)μg/min vs(0.18±0.04)g/24 h,(73.51±8.97)μg/min](P<0.05).③Before treatment,there was no significant difference in FBG,2 hPG and HbA1 c between the two groups(P>0.05).After treatment,the above indexes in the two groups were decreased(P<0.05).④After treatment,TC,TG and LDL-C the observation group were decreased.There were significant differences,compared with those in the same group before treatment[(4.81±0.65)mmol/L,(1.51±0.26)mmol/L,(3.63±0.22)mmol/L vs(6.51±0.51)mmol/L,(2.54±0.46)mmol/L,(4.07±0.36)mmol/L]and those in the control group after treatment[(4.81±0.65)mmol/L,(1.51±0.26)mmol/L,(3.63±0.22)mmol/L vs(6.51±0.43)mmol/L,(2.44±0.29)mmol/L,(4.05±0.45)mmol/L](P<0.05).Conclusion In the clinical treatment of elderly patients with type 2 diabetic nephropathy,the application of calcium ion antagonist nifedipine sustained-release tablets and angiotensin receptor blocker irbesartan can significantly lower the microalbuminuria excretion rate and protect renal function in patients.