摘要
目的探讨阿魏酸哌嗪联合厄贝沙坦对糖尿病肾病(DN)疗效及微循环的影响。方法选择2010年5月至2015年5月武汉科技大学附属普仁医院收治的200例DN患者,按照随机数字法分为联合治疗组(100例)和厄贝沙坦组(100例)。两组患者均给予常规降血糖及饮食治疗,厄贝沙坦组在此基础上口服厄贝沙坦片每次0.15 g,每日3次,连续治疗12周;联合治疗组在厄贝沙坦组治疗的基础上给予阿魏酸哌嗪片每次0.15 g,每日3次,治疗12周。比较两组患者的临床疗效以及治疗前后空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA_(1c))、血肌酐、24 h尿蛋白、血液流变学指标的水平,并计算尿白蛋白排泄率(UAER),比较两组患者的不良反应发生情况。结果联合治疗组总有效率为94.0%(94/100),高于厄贝沙坦组的81.0%(81/100)(P<0.05),联合治疗组的疗效也优于厄贝沙坦组(P<0.05)。治疗后,两组患者FPG、2 h PG、HbA_(1c)、血肌酐、24 h尿蛋白、UAER、全血黏度低切、全血黏度高切、全血还原黏度、血小板聚集率、血浆黏度、纤维蛋白原含量均显著低于治疗前(P<0.01),其中联合治疗组血肌酐、24 h尿蛋白、UAER、全血黏度、全血还原黏度、血小板聚集率、血浆黏度、纤维蛋白原水平均显著低于厄贝沙坦组[(70.5±4.4)mmol/L比(78.4±5.1)mmol/L、(0.35±0.02)g比(0.41±0.04)g、(64.4±4.5)μg/min比(73.4±3.8)μg/min、(7.5±1.5)m Pa·s比(8.6±1.6)m Pa·s、(5.0±0.4)m Pa·s比(5.6±0.6)m Pa·s、(6.8±1.3)m Pa·s比(7.9±1.5)m Pa·s、(41.6±7.4)%比(53.8±6.3)%、(1.70±0.18)m Pa·s比(1.81±0.21)m Pa·s、(2.8±0.4)g/L比(3.2±0.4)g/L](P<0.01)。联合治疗组不良反应发生率为5.0%(5/100),厄贝沙坦组为4.0%(4/100),比较差异无统计学意义(χ~2=0.116,P=0.733)。结论阿魏酸哌嗪联合厄贝沙坦能够显著提高DN的疗效、保护肾功能,其作用机制可能与改善肾微循环障碍有关。
Objective To explore the effect of piperazine fertdate combined with irbesartan for treatment of diabetic nephropathy（DN） and its influence on microcirculation. Methods A total of 200 DN patients treated in Puren Hospital Affiliated to Wuhan University of Science and Technology from May 2010 to May 2015 was collected,according to the ran- dom number method ,they were divided into a combined treatment group（ 100 cases） and an irbesartan group （100 cases）. Both groups were given conventional therapy （ general lowering blood sugar treatment and the diet treatment）, irbesartan group based on the conventional therapy was treated with irbesartan tablets ,0. 15 g every time ,3 times a day, 12 weeks as a course. Combined treatment group was given piperazine ferulate tablets based on irbesartan group ,0. 15 g every time ,3 times a clay, 12 weeks as a courses. The curative effect of the two groups were compared,fasting plasma glucose（FPG） ,postprandial 2 h plasma giucose （2 h PG）, glycosylatod hemoglobin （HbAlc）, serum creatinine ,24 h urine protein and blood rheology index of the two groups were measured before and after treatment, and the urinary albumin excretion rate （UAER） was calculated, and the adverse reactions of the two groups were compared. Results The total effective rate of combined treatment group was 94.0% （94/100）, higher than that of irbesartan group [ 81.0% （81/100） ] （ P 〈 O. 05 ）. After treatment, the FPG,2 h PG, HbAlo, serum creatinine,24 h urine protein, UAER, whole blood viscosity low shear, whole blood viscosity high shear, whole blood reduction viscosity ,platelet aggregation rate, plasma viscosity, fibrinogen content of two groups were significantly decreased （ P 〈 0. 01 ）, and FPG,2 h PG, HbAlc, serum creatinine, 24 hours urine protein, UAER, whole blood viscosity, whole blood reduction viscosity, platelet aggregation rate, plasma viscosity, fibrinogen content of combined treatment group were significantly lower than those of irbesartan group [ （70. 5 ± 4. 4） mmol/L vs （78.4 ± 5.1 ） mmol/L, （0.35±0.02） gvs （0.41 ±0.04） g,（64.4 ±4.5） μg/min vs （73.4±3.8） μg/min,（7.5 ±1.5） mPa ± s vs （8.6± 1.6） mPa.s,（5.0±0.4） mPa.svs （5.6 ±0.6） mPa· s,（6.8±1.3） mPa. s vs （7.9 ±1.5） mPa· s,（41.6± 7.4）% vs （53.8 ±6.3）%,（1.70±0. 18） mPa. svs （1.81±0.21） mPa. s,（2.8 ±0.4） g/Lvs （3.2±0.4） g/L] （P 〈 0. 01 ）. The adverse reactions rate of the combined treatment was 5： 0% （5/100）, of irbesartan group was 4. 0% （4/ 100） ,there was no significant difference between the two groups（ x^2 = 0. 116, P = 0. 733 ）. Conclusion Piperazine ferulate combined with irbesartan treatment of DN can significantly improve the curative effect, and protect the renal function, the mechanism of which may relate to the improvement of the renal microcirculation.
作者
冯光勇
黄伟
周峰
FENG Guangyong HUANG Wei ZHOU Feng.(Department of Endocrinology, Puren Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430081 China)
出处
《医学综述》
2017年第1期149-153,共5页
Medical Recapitulate
关键词
糖尿病肾病
微循环
阿魏酸哌嗪
厄贝沙坦
肾功能
Diabetic nephropathy
Microcirculation
Piperazine ferulate
Irbesartan
Renal function
