舒洛地特治疗糖尿病肾病合并视网膜病变的临床疗效观察  

Sulodexide for diabetic nephropathy complicated by retinopathy: A clinical observation

作　　者：王扬天[1] 彭丽[1] 叶小珍[1] 卢斌[1] 李洁[1] 顾萍[1] 孙玲君[1] 王坚[1] 

机构地区：[1]南京军区南京总医院内分泌科,南京210002

出　　处：《医学研究生学报》2010年第12期1269-1272,共4页Journal of Medical Postgraduates

摘　　要：目的目前,临床对于糖尿病肾病（diabetic nephropathy,DN）合并糖尿病视网膜病变（diabetic retinopathy,DR）患者治疗手段较少,疗效有限,而舒洛地特可以针对其共同的发病基础发挥作用,文中主要观察该药对这类患者的疗效及安全性。方法回顾性分析60例2型DN合并视网膜病变患者,24 h尿清蛋白排泄率（urinary albumin excrefion rate,UAER）30-300 mg,眼底镜检查证实DR,其中男32例,女28例,年龄32-70岁,糖尿病病程2.5-26年。将患者分为2组,每组30例。对照组：予以前列地尔10μg,静脉滴注,1次/d,联合厄贝沙坦150 mg,口服,1次/d,疗程2周,然后序贯欧洲越桔花青苷/β-胡萝卜素0.4 g,口服,3次/d,联合厄贝沙坦150 mg,口服,1次/d,疗程14周。舒洛地特组：舒洛地特600 LSU,静脉滴注,1次/d,疗程4周,然后序贯250 LSU,口服,2次/d,疗程12周。比较治疗16周前后指标变化,所检测指标包括UAER、眼底镜检查、空腹血糖（fasting plasma glucose,FPG）、糖化血红蛋白（hemoglobin Alc,HbAlc）、谷丙转氨酶（alanine aminotransferase,ALT）、谷草转氨酶（aspartate aminotransferase,AST）、血尿素氮（bolld urea nitrogen,BUN）、血肌酐（serum creatinine,SCr）、纤维蛋白原（fibringen,FIB）。结果对照组用药前后UAER,从治疗前（150.06±80.79）mg/24 h下降至治疗后的（93.3±52.33）mg/24 h;舒洛地特组UAER从（137.71±74.15）mg/24 h下降至（91.70±61.89）mg/24 h,用药前后比较,2组UAER差异均有显著性统计学意义（P〈0.01）。治疗16周后,对照组UAER下降56.76mg/24h,舒洛地特组下降46.01mg/24h,2组间比较无显著性差异（P〉0.05）。经眼底镜检查眼底病变分级,2组患者治疗前后均无显著性差异,组间亦无显著性差异（P〉0.05）。2组用药前后FPG、HbAlc、ALT、AST、BUN、SCr、FIB等指标差异无统计学意义。结论舒洛地特能降低微量清蛋白尿期2型DN患者的UAER,延缓DN及DR进展。Objective While the therapeutic means and efficacy remain inadequate in the treatment of diabetic nephropathy（DN） complicated by diabetic retinopathy（DR）,Sulodexide is shown to act on the common basis of the two pathological processes.The purpose of this study is to investigate the efficacy and safety of Sulodexide for patients with DN complicated by DR.Methods This study included 60 cases of type 2 DN complicated by DR confirmed by ophthalmofunduscopy and the 24 h urinary albumin excretion rate（UAER,30-300mg）,32 males and 28 females,aged 32-70 years and with a diabetic history of 2.5-26 years.The patients were equally divided into a control and a Sulodexide group.The former received intravenous drip of Prostaglandin E1 at 10 μg qd combined with oral Irbesartan at 150mg qd for 2 weeks,followed by oral Difrarel at 0.4g tid combined with oral Irbesartan at 150mg qd for 14 weeks,while the latter was treated by intravenous drip of Sulodexide at 600 LSU qd for 4 weeks,and then orally at 250 LSU bid for 12 weeks.At 16 weeks after the initiation of medication,comparisons were made between the two groups in the changes of UAER,results of funduscopic examination,fasting plasma glucose（FPG）,glycosylated hemoglobin（HbAlc）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,creatinine（Cr）,and fibrin original（FIB）.Results UAER was decreased from（150.06±80.79） mg/24h before the treatment to（93.3±52.33） mg/24h after it in the control group,and from（137.71±74.15） mg/24h to（91.70±61.89） mg/24h in the Sulodexide group,with significant differences in both of the groups（P0.01）.At 16 weeks,however,UAER was reduced by 56.76 mg/24 h in the control and 46.01 mg/24 h in the Sulodexide group,with no significant differences between the two groups（P0.05）.Ophthalmofunduscopy showed no significant differences in the grade of fundus oculi lesion either between the two groups or before and after the medication（P0.05）,nor were there any significant differences in FPG,

关 键 词：舒洛地特 糖尿病肾病 糖尿病视网膜病变 

分 类 号：R587.1[医药卫生—内分泌]