陈毅光 刘枘岢 李雯翀 周敏华 朱咏瑶

【摘要】 目的：探討前列地尔联合依帕司他治疗对糖尿病肾病（diabetic nephropathy，DN）患者肾功能及蛋白水平的影响。方法：选取2017年1月-2019年12月本院收治的92例DN患者，按照随机数字表法将其分为对照组和观察组，各46例。两组均接受胰岛素、降糖药等基础治疗，对照组静脉滴注前列地尔注射液，观察组在对照组基础上服用依帕司他，连续治疗8周，观察对比两组的临床疗效。结果：观察组治疗4、8周后的BUN水平和治疗8周后的Scr水平与治疗前比均更低，且治疗8周后，观察组的Scr、BUN水平均低于对照组，差异均有统计学意义（P<0.05）。治疗4、8周后，观察组的24 h尿蛋白定量与治疗前比较均降低，治疗8周后，对照组的24 h尿蛋白定量与治疗前比较降低，且观察组治疗4、8周后的24 h尿蛋白定量均低于对照组，差异均有统计学意义（P<0.05）。治疗8周后，两组的SF-36评分较治疗前均升高，且观察组SF-36评分高于对照组，差异均有统计学意义（P<0.05）。治疗8周后，观察组的临床总有效率高于对照组（P<0.05）。两组的不良反应发生率比较，差异无统计学意义（P>0.05）。结论：前列地尔联合依帕司他治疗DN患者的效果确切，可有效减少24 h尿蛋白定量，改善患者的肾功能指标，安全性好，值得临床应用。

【关键词】 前列地尔 依帕司他 糖尿病肾病 24 h尿蛋白定量

Effect of Alprostadil Combined with Epalrestat on Renal Function and Urine Protein Level in Patients with Diabetic Nephropathy/CHEN Yiguang， LIU Ruike， LI Wenchong， ZHOU Minhua， ZHU Yongyao. //Medical Innovation of China， 2021， 18（05）： 0-059

[Abstract] Objective： To explore the effect of Alprostadil combined with Epalrestat on renal function and urine protein level in patients with diabetic nephropathy. Method： A total of 92 patients with DN admitted to our hospital from January 2017 to December 2019 were selected， they were divided into control group and observation group according to random number table method， 46 cases in each group. Both groups received basic therapy such as insulin and hypoglycemic drugs， the control group was intravenously infused with Alprostadil Injection， the observation group was treated with Epalrestat on the basis of the control group for 8 weeks of continuous treatment. The clinical effect of the two groups were observed and compared. Result： The levels of BUN in the observation group 4， 8 weeks after treatment and Scr level after 8 weeks of treatment group were lower than before treatment， after 8 weeks of treatment， the levels of Scr and BUN in the observation group were lower than the control group， the differences were statistically significant （P<0.05）.  After 4 and 8 weeks of treatment， the 24 h urine protein in the observation group decreased compared with that before treatment， after 8 weeks of treatment， the 24 h urine protein in the control group decreased compared with that before treatment， the 24 h urine protein level in the observation group after 4 and 8 weeks of treatment were lower than those in the control group， the differences were statistically significant （P<0.05）. after 8 weeks of treatment， the SF-36 score in both groups was higher than that before treatment， the SF-36 score in the observation group was higher than that in the control group， the difference was statistical significance （P<0.05）. After 8 weeks of treatment， the total clinical effective rate of observation group was higher than that of control group （P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P>0.05）. Conclusion： The efficacy of Alprostadil combined with Epalrestat in the treatment of DN patients is definite， it can effectively reduce the 24 h urine protein quantification， improve the patients renal function indexes， it has good safety and is worthy of clinical application.

[Key words] Alprostadil Epalrestat Diabetic nephropathy 24 h urine protein quantification

First-authors address： Songshan Lake Central Hospital of Dongguan City， Dongguan 523326， China

doi：10.3969/j.issn.1674-4985.2021.05.015

糖尿病肾病（diabetic nephropathy，DN）属于糖尿病常见的微血管并发症，临床特征为蛋白尿、渐进性肾功能损害、高血压、水肿[1]，可逐渐发展为肾功能衰竭，需要血液透析或肾移植治疗，病死率高，医疗花费巨大，严重者可危及生命[2]。目前，临床对于DN患者尚无特效治疗手段，主要以积极预防、早期筛查、综合干预为主，采用降血糖、降血压、控制尿蛋白等方式以延缓疾病发展，保护患者肾功能[3]。本研究观察探讨前列地尔联合依帕司他治疗对DN患者肾功能、24 h尿蛋白定量、生活质量及临床疗效的影响，现报道如下。

1 资料与方法

1.1 一般资料 选取2017年1月-2019年12月本院收治的92例DN患者。纳入标准：（1）诊断符合1999年WHO中2型糖尿病相关标准[4];（2）空腹血糖≥6.1 mmol/L;（3）按照Mogensen糖尿病肾病分期法符合Ⅲ期标准[5];（4）24 h尿蛋白定量>150 mg。排……