前列腺素E1治疗糖尿病肾病1年的随访研究  

Therapeutic effect of prostaglandin E1 on diabetic nephropathy: a one-year follow-up study

作　　者：李鹏飞[1] 牟亚汝[1] 辛颖[2] 曲勇 廖琳[1] 

机构地区：[1]山东大学附属省立医院内分泌科,山东济南250021 [2]济宁市第一人民医院内分泌科,山东济宁272000 [3]山东铝业医院内分泌科,山东淄博255000

出　　处：《南方医科大学学报》2010年第3期482-485,共4页Journal of Southern Medical University

基　　金：山东省自然科学基金(Y2006C76);留学回国人员科技活动择优资助项目(鲁人办发[2007]226号)

摘　　要：目的观察前列腺素E1(PGEl)治疗不同时期糖尿病肾病(DN)随访1年的疗效。方法糖尿病肾病患者根据Mogensen DN诊断标准分为Ⅲ、Ⅳ、Ⅴ期。其中Ⅳ期患者根据尿蛋白水平分为Ⅳ早期(尿蛋白<1.5g/d)、Ⅳ中期(1.5g/d<尿蛋白<2.5g/d)和Ⅳ晚期(尿蛋白>2.5g/d)。各期患者再随机给予4种治疗方案:PGE1组、PGEl+血管紧张素转换酶抑制剂(ACEI)组、ACEI组和空白对照组。测定各组治疗前及治疗后15d、1年的24h尿蛋白和24h尿微量白蛋白水平。结果(1)Ⅲ期及Ⅳ早期患者:PGE1+ACEI组和PGE1组治疗后15d及1年时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),PGE1+ACEI组下降幅度始终大于ACEI组(P<0.01或P<0.05)。(2)Ⅳ中期及Ⅳ晚期患者:PGE1+ACEI组治疗后15d及1年时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),下降幅度始终大于ACEI组(P<0.01)。PGE1组治疗后15d时,两指标水平较治疗前明显下降(P<0.01),但治疗后1年时两指标下降幅度减小且水平高于ACEI组(P<0.05)。(3)Ⅴ期患者:PGE1+ACEI组和PGE1组治疗后15d时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),下降幅度大于ACEI组(P<0.01)。治疗后1年时,PGE1+ACEI组的两指标水平与治疗前无统计学差异,但仍低于ACEI组;PGE1组及ACEI组的两指标水平较治疗前升高(P<0.05),两组之间无统计学差异。结论PGE1对早期糖尿病肾病治疗效果优于晚期。PGE1与ACEI联合应用疗效最好,随访1年时疗效仍好于单用前列腺素E1及ACEI。Objective To investigate the therapeutic effect of prostaglandin E1 （PGEl） on diabetic nephropathy （DN） after a one-year treatment. Methods According to Mogensen DN diagnostic criteria, the patients were divided into DN stages III, IV and V groups. Patients in stage IV nephropathy were subdivided into three groups according to the proteinuria, namely early stage IV （protienuria less than 1.5 g/day）, mid-stage IV （protienuria between 1.5 and 2.5 g/day） and late stage IV （protienuria above 2.5 g/day）. The patients were randomly given PGEl, PGEl plus angiotensin-converting enzyme inhibitor （ACEI）, ACEI mono-therapy or basal treatment （control group）. Proteinuria and albuminuria were measured before and at 15 days and 1 year of the treatment. Results In the patients in DN stages III and early stage IV, proteinuria and albuminuria decreased significantly after 15 days and 1 year of treatment with PGEl＋ACEI and PGEl （P0.01）, and the decrements were greater than that in patients receiving ACEI only （P0.01 or P0.05）. In the patients in mid- and late stage IV nephropathy, proteinuria and albuminuria decreased significantly in PGEl＋ACEI group after 15 days and 1 year of treatment （P0.01）, showing greater decrement than in ACEI group （P0.01 ）. Proteinuria and albuminuria decreased significantly in PGEl group after 15 days of treatment （P0.01）, but remained higher than that in ACEI group at one year （P0.05）. In the patients with stage V nephropathy, significant proteinuria and albuminuria reduction occurred in PGEl＋ACEI and PGEl groups at 15 days （P0.01） with a greater decrement than that in ACEI group （P0.01 or P0.05）. In PGEl＋ACEI group, proteinuria and albuminuria showed no significant changes at one year but were lower than those in ACEI group （P0.05）. Proteinuria and albuminuria increased significantly in ACEI and PGEl group after the treatment but were comparable between the two groups （P0.05）.Conclusions The therapeutic effects are much better

关 键 词：糖尿病肾病 前列腺素E1 尿蛋白 尿微量白蛋白 

分 类 号：R587.2[医药卫生—内分泌]