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目的评价贝前列素钠联用氯沙坦钾对糖尿病肾病早期患者肾功能及尿微量蛋白指标的影响。方法 68例糖尿病肾病患者分为试验组和对照组,各34例。对照组口服贝前列素钠片,每次40μg,每天3次;试验组在对照组基础上口服氯沙坦钾片,每次50 mg,每天1次,疗程均为12周。观察治疗前后肾功能(血清肌酸酐、尿素氮、同型半胱氨酸、胱抑素C),尿微量蛋白指标(β_2微球蛋白、尿微量清蛋白、尿微量清蛋白/尿肌酸酐、24 h尿白蛋白排泄率),血压、血糖及糖化血红蛋白变化情况。结果治疗后,2组尿素氮、同型半胱氨酸、胱抑素C、β_2微球蛋白、尿微量清蛋白、尿微量清蛋白/尿肌酸酐、24 h尿白蛋白排泄率的水平较治疗前明显降低(P<0.05),其中试验组同型半胱氨酸、胱抑素C、尿微量蛋白指标水平较对照组降低更为显著(P<0.05),而血清肌酸酐、尿素氮无明显变化(P>0.05)。2组血压治疗后较治疗前降低,血糖及糖化血红蛋白无明显变化(P>0.05)。2组均未出现咳嗽、血钾升高等其他严重不良反应。结论贝前列素钠联用氯沙坦钾能保护糖尿病肾病早期患者肾内皮细胞,改善肾功能,有效减轻尿蛋白,有效延缓病情进展,安全性好。
Objective To evaluate the effects of beraprost sodium combined with losartan on renal function and urinary protein in early stage of diabetic nephropathy. Methods 68 patients with diabetic nephropathy were divided into experimental group and control group, 34 cases each. Control group oral beraprost sodium tablets, each 40μg, 3 times a day; the experimental group in the control group on the basis of oral losartan potassium tablets, each 50 mg, day 1, the course of treatment were 12 weeks. The changes of renal function (serum creatinine, urea nitrogen, homocysteine and cystatin C), urinary microalbuminuria (β_2 microglobulin, urine microalbuminuria, urine microalbuminuria / urine creatinine, 24 h urinary albumin excretion rate), blood pressure, blood glucose and glycosylated hemoglobin changes. Results After treatment, the levels of urea nitrogen, homocysteine, cystatin C, β 2 microglobulin, urine microalbuminuria, urine microalbuminuria / urine creatinine, urinary albumin excretion rate 24 h (P <0.05). The levels of homocysteine, cystatin C and urine microalbumin in experimental group were significantly lower than those in control group (P <0.05), while serum creatinine and urea nitrogen had no significant difference Change (P> 0.05). After treatment, the blood pressure in the two groups was lower than that before treatment, and the blood glucose and glycosylated hemoglobin had no significant changes (P> 0.05). There were no other serious adverse reactions such as cough, hyperkalemia and other two groups. Conclusion Bezoprost combined with losartan potassium can protect renal endothelial cells in early diabetic nephropathy, improve renal function and reduce proteinuria effectively, effectively delay the progression of the disease, and have good safety.