目的 探討雷米普利與低分子量肝素鈣聯(lián)合用藥治療老年糖尿病腎病的療效和作用機制。方法 選取2013年4月—2014年4月上海市浦東醫(yī)院收治的糖尿病腎病患者78例, 隨機分為兩組, 治療組給予雷米普利片, 口服, 2.5 mg/次, 2次/d, 同時sc給予低分子量肝素鈣注射液, 5 000 U/次, 1次/d;對照組僅sc給予低分子量肝素鈣注射液5 000 U/次, 1次/d。治療4周后評價兩組的血壓、腎功能、凝血功能變化、抗氧化指標和療效。結果 治療后, 對照組尿白蛋白排泄率(UAER)、24 h尿蛋白、血尿素氮(BUN)、收縮壓與治療前比較差異具有統(tǒng)計學意義(P<0.01), 治療組UAER、24 h尿蛋白、肌酐(Cr)、BUN、纖維蛋白原(FIB)、血壓與治療前比較差異均具有統(tǒng)計學意義(P<0.01), 且與對照組比較差異具有統(tǒng)計學意義(P<0.01);治療組與對照組在丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽(GSH)和過氧化氫酶(CAT)比較差異具有統(tǒng)計學意義(P<0.05、0.01);治療組的有效率為89.74%, 對照組的為79.49%, 兩組比較差異具有統(tǒng)計學意義(P<0.05)。 結論 雷米普利與低分子肝素鈣聯(lián)合用藥能夠改善機體酶性抗氧化系統(tǒng)對自由基清除, 從而提高對老年糖尿病腎病的療效。

Objective To investigate the efficacy and mechanism of ramipril combined with low molecular weight heparin calcium in treatment of elderly diabetic nephropathy. Methods Patients (78 cases) with diabetic nephropathy in Shanghai Pudong Hospital from April 2013 to April 2014 were randomly divided into two groups. The patients in the control group were sc administered with Low Molecular Heparin Calcium Injection 5 000 U/time, once daily. Patients in treatment group were po administered with Ramipril Tablets on the basis of control group, 2.5 mg/time, twice daily. Blood pressure, renal function, blood coagulation function, anti-oxidant index, and efficacy were evaluated after 4 weeks. Results After treatment, the UAER, 24 h urinary protein, BUN, and systolic blood pressure in control group were significantly improved, and the difference was statistically significant before and after the treatment in the same group (P < 0.01). The UAER, 24 h urinary protein, Cr, BUN, FIB, blood pressure in treatment group were improved, and the difference was statistically significant before and after the treatment in the same group (P < 0.01), and there was significant difference between the two groups (P < 0.01). The levels of MDA, SOD, GSH and CAT between treatment group and control group were statistically significant (P < 0.05, 0.01). The efficacy in the control and treatment groups was 89.74% and 79.49%, respectively, and there were differences between two groups (P < 0.05). Conclusion Ramipril combined with low molecular weight heparin calcium can improve the body enzymatic antioxidant system, so as to improve the efficacy of diabetic nephropathy.

上海市浦東新區(qū)衛(wèi)生系統(tǒng)重點學科建設資助項目(PWZx2014-11);上海市浦東新區(qū)醫(yī)學領先人才項目(PWRI2012-05);復旦大學優(yōu)勢建設學科資助項目