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目的观察低分子肝素与雷米普利单用或联用治疗老年糖尿病肾病的疗效。方法 210例老年糖尿病肾病患者随机分为三组,A组:低分子肝素2500～5000IU/d皮下注射;B组:口服雷米普利5～10mg/d;C组:联合应用低分子肝素和雷米普利,剂量同前。疗程均为4周。观察治疗前后24h尿蛋白、肾功能、血液流变学、凝血功能和血脂等指标变化。结果三组治疗后与治疗前相比,24h尿蛋白、尿β2微球蛋白(β2-MG)水平和血压均降低(P<0.05或P<0.01),联合治疗组降低幅度大于另两组(均P<0.05);三组治疗后估算的肾小球滤过率(eGFR)水平均升高(P<0.05),联合治疗组升高幅度大于另两组(均P<0.05)。结论低分子肝素与雷米普利治疗糖尿病肾病均可获得良好作用,且两药合用较两药单用肾保护作用更显著。
Objective To observe the effect of low molecular weight heparin and ramipril alone or in combination on the treatment of diabetic nephropathy in the elderly. Methods 210 elderly patients with diabetic nephropathy were randomly divided into three groups: group A: low molecular weight heparin 2500 ~ 5000IU / d subcutaneous injection; group B: oral ramipril 5 ~ 10mg / d; group C: combination of low molecular weight heparin and Ramipril, the same dose as before. The course of treatment is 4 weeks. 24h urine protein, renal function, hemorrheology, coagulation function and blood lipid and other indicators were observed before and after treatment. Results The levels of urinary protein and urinary β2-microglobulin (β2-MG) and blood pressure in the three groups after treatment were lower than those before treatment (P <0.05 or P <0.01), and the decrease was greater in the combined treatment group than in the other two groups (All P <0.05). The levels of glomerular filtration rate (eGFR) in the three groups were significantly increased after treatment (P <0.05), and the increase rate in the combined treatment group was higher than the other two groups (all P <0.05). Conclusion Low molecular weight heparin and ramipril can be used to treat diabetic nephropathy, and the combination of two drugs is more effective than the two drugs alone.