李会芳 苗霞 朱昭明

[摘要] 目的 探讨生长抑素类似物对糖尿病肾病患者大量蛋白尿的临床观察。方法 选取2015年1月—2017年5月收治的符合纳入标准的糖尿病肾病患者60例，随机分为研究组和对照组，各30例。对照组：予常规治疗；研究组：在常规治疗基础上加用生长抑素类似物奥曲肽。疗程为4周，观察治疗前后两组患者的尿蛋白定量、肾小球滤过率、低密度脂蛋白、血糖、糖化血红蛋白等疗效指标及不良反应情况。 结果 治疗4周后，研究组在尿蛋白定量、低密度脂蛋白、血糖、糖化血红蛋白等方面优于对照组（P<0.05）。结论 生长抑素类似物奥曲肽在治疗糖尿病肾病大量蛋白尿方面，能显著降低患者尿蛋白、改善血糖、脂代谢异常，从而延缓肾功能进展，安全性较高。

[关键词] 糖尿病肾病；生长抑素类似物奥曲肽；尿蛋白定量

[中图分类号] R59 [文献标识码] A [文章编号] 1672-4062（2018）06（a）-0001-04

[Abstract] Objective To study the clinical observation on somatostatin analogue in massive proteinuria of diabetic nephropathies. Methods 60 cases of patients with diabetic nephropathies meeting the inclusive standards from January 2015 to May 2017 were selected and randomly divided into two groups with 30 cases in each， the control group used the routine therapy， while the research group added the somatostatin analogue octreotide on the basis of the control group， and the curative effect was four weeks， and the curative effect indicators such as urinary protein quantitation， glomerular filtration rate， low density lipoprotein， blood glucose and glycosylated hemoglobin and adverse reactions before and after treatment were observed. Results In four weeks after treatment， the urinary protein quantification， low density lipoprotein， blood glucose and glycosylated hemoglobin in the research group were better than those in the control group（P<0.05）. Conclusion The somatostatin analogue octreotide in massive proteinuria of diabetic nephropathies can obviously reduce the urine protein， and improve the abnormal blood glucose and lipid metabolism thus prolonging the progression of renal function， and the safety is high.

[Key words] Diabetic nephropathies； Somatostatin analogue octreotide； Urine protein quantitation

糖尿病肾病是糖尿病的一种微血管并发症，有其特异的临床演变过程，长期高血糖、晚期糖基化产物、细胞因子、多种激素紊乱参与，导致肾小球入球动脉紧张性下降，肾小球血流动力学异常，滤过膜通透性增加、肾小球系膜基质增多。目前临床仍以尿蛋白逐渐增高、肾小球滤过率下降作为分期标准，临床观察，患者一旦进入大量蛋白尿，肾功能进行性进展，短期内发展为终末期肾病，需行肾替代治疗。大量基础、临床研究证实：目前，由糖尿病肾病导致血液透析患者已上升至首位，如何延缓糖尿病肾病进展一直是该科探索的课题。生长抑素类似物增加肾小球入球动脉张力，保护足细胞，下调血管内皮细胞生长因子对肾小球滤过膜、系膜细胞的病理损害，抑制系膜基质分泌，延缓糖尿病肾病的进展。……