氯沙坦联合前列腺素 E1治疗早期糖尿病肾病的临床观察  

Effect of combination therapy of losartan and prostaglandin E1 on early -phase diabetic kidney disease

作　　者：李硕良 冯秀娟 何华平 黎杰 谭瑞珠 

机构地区：[1]台山市人民医院内分泌科,广东省台山529200

出　　处：《中国基层医药》2016年第23期3589-3592,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：观察氯沙坦联合前列腺素 E1治疗早期糖尿病肾病的短期及远期疗效以及安全性。方法117例早期糖尿病肾病患者，按数字表法随机分组采用氯沙坦（ARB 组）、前列腺素 E1（PGE1组）、氯沙坦＋前列腺素 E1（ARB ＋PGE1组）治疗，并进行6个月的治疗和随访观察，比较各组治疗前、治疗14 d、治疗6个月的尿白蛋白排泄率（UAER）、血肌酐（CR）、肌酐清除率（CCr）、血钾（K）水平。结果ARB 组38例、PGE1组39例、ARB ＋PGE1组40例均完成了治疗6个月的随访评估。与治疗前相比，治疗14 d、治疗6个月各组患者 UAER 均有下降[（88．2±42．8）μg／min、（61．0±22．0）μg／min、（50．3±15．2）μg／min；（58．0±22．8）μg／min、（50．6±18．1）μg／min、（31．7±7．3）μg／min]，差异均有统计学意义（t ＝8．517、7．056、7．989，t ＝7．442、8．947、7．992，均 P ＜0．01）；治疗6个月 ARB ＋PGE1组下降幅度大于 ARB、PGE1组[（31．7±7．3）μg／min、（50．6±18．1）μg／min、（58．0±22．8）μg／min]。治疗14 d，CR、CCr 水平均无明显改变（P ＞0．05）。治疗6个月，CR 下降、CCr 上升[（94．6±19．0）μmol／L、（89．2±19．8）μmol／L、（85．0±16．2）μmol／L；（60．1±6．3）mL／min、（62．0±6．0）mL／min、（64．3±6．1）mL／min]差异均有统计学意义（t ＝9．283、9．978、9．876，t ＝－2．398、－2．838、－3．088，均 P ＜0．05）。治疗14 d、6个月各组血钾水平无明显改变（P ＞0．05）。结论氯沙坦联合前列腺素 E1治疗早期糖尿病肾病有明显的短期和远期效果，是一种安全有效的治疗方法。Objective To assess the efficacy and safety of losartan combined with prostaglandin E1 therapy for diabetic nephropathy at early phase.Methods 117 patients with diabetic nephropathy at stage 3 were randomly treated with losartan （ARB）,prostaglandin E1 （PGE1）or losartan plus prostaglandin E1 （ARB ＋PGE1）.Patients were followed up for 6 months,the urinary albumin excretion rate（UAER）,serum creatinine（CR）,creatinine clearance rate （CCr）,serum potassium（K）were observed at 14th day and 6th month after the initiation of therapy.Results 117 patients （ARB,n =38;PGE1,n =39;ARB ＋PGE1,n =40）finished the follow -up.There were significant differences in UAER on the 14th day and 6th month[（88.2 ±42.8）μg/min,（61.0 ±22.0）μg/min,（50.3 ±15.2）μg/min;（58.0 ±22.8）μg/min,（50.6 ±18.1）μg/min,（31.7 ±7.3）μg/min],respectively （t =8.517,7.056,7.989, t =7.442,8.947,7.992,all P 〈0.01 ）among the three groups,the patients in ARB ＋PGE1 group got the lowest UAER after 6 -month therapy[（31.7 ±7.3）μg/min,（50.6 ±18.1）μg/min,（58.0 ±22.8）μg/min].There were no significant differences in CR and CCr on day 14 （all P 〉0.05 ）,but significant differences on the 6th month examination （t =9.283,9.978,9.876,t =-2.398,-2.838,-3.088,all P 〈0.05）.The lowest CR and the highest CCr were found in the ARB ＋PGE1 group.There were no significant differences in serum potassium levels after both 14 days and 6 months of therapy among the three groups（all P 〉0.05）.Conclusion The results suggest that both short -term and long -term treatment with ARB and PGE1 is effective and safe for early -phase diabetic nephropathy.

关 键 词：糖尿病肾病 早期 氯沙坦 前列腺素E1 

分 类 号：R587.2[医药卫生—内分泌]