达格列净联合厄贝沙坦治疗糖尿病肾病的临床疗效  

Clinical Efficacy of Dapagliflozin Combined with Irbesartan in the Treatment of Diabetic Nephropathy

作　　者：邴兆伟[1] 陈斌[2] BING Zhaowei;CHEN Bin(Department of Endocrinology,Qingdao Municipal Hospital,Qingdao 266011,China;Department of Emergency,Qingdao Municipal Hospital,Qingdao 266011,China)

机构地区：[1]青岛市市立医院内分泌科,山东青岛266011 [2]青岛市市立医院急诊科,山东青岛266011

出　　处：《医学综述》2018年第23期4763-4767,4772,共6页Medical Recapitulate

摘　　要：目的探讨达格列净联合厄贝沙坦治疗糖尿病肾病的临床疗效。方法选择2016年10月至2017年12月青岛市市立医院收治的126例糖尿病肾病患者为研究对象,按照随机数字法分为观察组和对照组,各63例。两组患者均给予糖尿病教育、饮食、口服降血糖药或注射胰岛素等常规治疗,对照组在常规治疗的基础上给予厄贝沙坦治疗,观察组在常规治疗基础上给予达格列净联合厄贝沙坦治疗。观察两组患者的临床疗效,治疗前后的血脂、血清胱抑素C(Cys C)、同型半胱氨酸(Hcy)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、单核细胞趋化蛋白1(MCP-1)、血肌酐、糖化血红蛋白(Hb A1c)、24 h尿白蛋白排泄率(UAER)、24 h尿蛋白定量水平及不良反应发生情况。结果观察组总有效率显著高于对照组[92. 06%(58/63)比71. 43%(45/63)](P <0. 05)。治疗后观察组总胆固醇、低密度脂蛋白胆固醇显著低于对照组[(3. 47±0. 56) nmol/L比(3. 82±0. 49) nmol/L,(1. 77±0. 41) nmol/L比(1. 92±0. 39) nmol/L](P <0. 05)。治疗后观察组血清Cys C、Hcy、NGAL、MCP-1水平均低于对照组[(0. 89±0. 11) mg/L比(1. 27±0. 22) mg/L,(9. 36±2. 16)μmol/L比(11. 34±3. 25)μmol/L,(71. 61±21. 36)μg/L比(79. 81±23. 46)μg/L,(202. 39±60. 18) ng/L比(263. 58±36. 52) ng/L](P <0. 05)。治疗后观察组血肌酐、24 h UAER、Hb A1c、24 h尿蛋白定量低于对照组[(61.25±15.57)μmol/L比(67.59±15.38)μmol/L,(75. 86±14. 26) mg比(82. 97±14. 23) mg,(7. 34±1. 21)%比(7. 88±1. 07)%,(1. 43±0. 19) g比(2. 23±0. 49) g](P <0. 05)。两组患者治疗过程中均未见明显不良反应发生。结论达格列净联合厄贝沙坦治疗糖尿病肾病可明显提高治疗效果,降低血清Cys C、Hcy、NGAL、MCP-1水平,保护肾功能。Objective To explore the clinical efficacy of dapagliflozin combined with irbesartan in the treatment of diabetic nephropathy.Methods A total of126patients with diabetic nephropathy admitted to Qingdao Municipal Hospital from Oct.2016to Dec.2017were divided into an observation group and a control group according to the random number method,63cases in each group.Both groups were given routine treatments including diabetes education,diet,oral hypoglycemic drugs or insulin injection.The control group was treated with irbesartan on the basis of the routine treatment,while the observation group was given the combination of dapagliflozin and irbesartan on the basis of the routine treatment.The clinical efficacy,serum cystatin C(Cys C),homocysteine(Hcy),neutrophil gelatinase associated lipoprotein(NGAL),monocyte chemoattractant protein-1(MCP-1),serum creatinine,glycated hemoglobin(HbA1c),24h urinary albumin excretion rate(UAER),24h urine protein level and incidence of adverse reactions of the two groups were observed.Results The total effective rate of the observation group was significantly higher than that of the control group[92.06%(58/63)vs71.43%(45/63)](P<0.05).The total cholesterol,low density lipoprotein cholesterol in the observation group were significantly lower than those in the control group after treatment[(3.47±0.56)nmol/L vs(3.82±0.49)nmol/L,(1.77±0.41)nmol/L vs(1.92±0.39)nmol/L](P<0.05).After treatment,the levels of Cys C,Hcy,NGAL and MCP-1in serum of the observation group were lower than those of the control group[(0.89±0.11)mg/L vs(1.27±0.22)mg/L,(9.36±2.16)μmol/L vs(11.34±3.25)μmol/L,(71.61±21.36)μg/L vs(79.81±23.46)μg/L,(202.39±60.18)ng/L vs(263.58±36.52)ng/L](P<0.05).The levels of serum creatinine,UAER,HbA1c and24h urinary protein in the observation group were lower than those in the control group after treatment[(61.25±15.57)μmol/L vs(67.59±15.38)μmol/L,(75.86±14.26)mg vs(82.97±14.23)mg,(7.34±1.21)%vs(7.88±1.07)%,(1.43±0.19)g vs(2.23±0.49)g](P<0.05).No significant adverse

关 键 词：糖尿病肾病 达格列净 厄贝沙坦 中性粒细胞明胶酶相关脂质运载蛋白 单核细胞趋化蛋白1 

分 类 号：R587.2[医药卫生—内分泌]