目的 探討前列地爾序貫治療糖尿病腎病的臨床療效和安全性.方法 選取2009年7月—2014年7月朝陽市第二醫(yī)院內(nèi)分泌科收治的2型糖尿病且初次診斷為糖尿病腎病臨床前期患者116例,隨機分為對照組(38例),前列地爾組(39例)和前列地爾序貫組(39例).對照組給予常規(guī)治療方案,前列地爾組在對照組基礎上第1、2周加用前列地爾注射液,靜脈滴注,2 mL/次,1次/d,第3、4周繼續(xù)常規(guī)治療.前列地爾序貫組第1、2周治療方法同前列地爾組,第3、4周采用常規(guī)治療聯(lián)合口服貝前列素鈉片,1片/次,3次/d.3組患者均連續(xù)治療4周.比較3組治療前后總膽固醇(TC)、三酰甘油(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)尿素氮(BUN)、肌酐(Cr)、24 h尿微量白蛋白(24 h UMA)、總蛋白、24 h尿6-酮前列素F1α(6-keto-PGF1α)、血栓素B2和腎動脈血管阻力指數(shù)的變化情況.結果 治療后,3組TC、TG、LDL-C、24 h UMA、尿總蛋白、Cr、BUN、血栓素B2、腎動脈阻力指數(shù)均顯著降低,HDL-C、24 h尿6-keto-PGF1α顯著升高,同組治療前后差異有統(tǒng)計意義(P<0.05).且治療后,前列地爾組、前列地爾序貫組這些指標改善程度優(yōu)于對照組,而前列地爾序貫組優(yōu)于前列地爾組,差異有統(tǒng)計學意義(P<0.05).結論 前列地爾序貫治療糖尿病腎病具有較好的臨床療效,可明顯改善患者血脂水平和腎功能,同時還可升高24 h尿6-keto-PGF1α,降低血栓素B2和腎動脈阻力指數(shù),值得臨床推廣應用.

Objective To investigate the curative effect and safety of sequential therapy of alprostadil in treatment of diabetic nephropathy. Methods Patients suffered from diabetic nephropathy from July 2009 to July 2014 in the Second Hospital of Chaoyang City (116 cases) were collected and randomly divided into control (38 cases), alprostadil (39 cases), and alprostadil sequential (39 cases) groups. Patients in the control group were given conventional treatment. Patients in the alprostadil group were iv administered with Alprostadil Injection in the first two weeks, 2 mL/time, once daily, and accepted conventional treatment in the third and fourth weeks. The treatment in the alprostadil sequential group were the same as the alprostadil group in the first two weeks, and the patients in alprostadil sequential group were po administered with Beraprost Sodium Tablets, 1 tablet/time, three times daily. The patients in three groups were treated for 4 weeks. The changes of TC, TG, HDL-C, LDL-C, BUN, Cr, 24 h UMA, total protein, 24 h 6-keto-PGF1α, thromboxane B2, and resistance indexes of renal artery in three groups were compared. Results After treatment, TC, TG, LDL-C, 24 h UMA, total protein, Cr, BUN, thromboxane B2, and resistance indexes of renal artery in three groups were significantly reduced, HDL-C and 24 h 6-keto-PGF1α were significantly increased, and the differences were statistically significant before and after treatment in the same group (P < 0.05). After treatment, these indexes in the alprostadil and alprostadil sequential groups improved better than those of control group, while the indexes in the alprostadil group improved better than those of alprostadil . Conclusion Sequential therapy of alprostadil has good clinical effect in treatment of diabetic nephropathy, and can obviously improve the level of blood lipid and renal function, at the same time can also elevate 24 h 6-keto-PGF1α and reduce thromboxane B2 and resistance index of renal artery, which is worthy of clinical application.

國家自然科學基金資助項目(81000329)