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目的观察雷公藤多甙治疗早中期糖尿病肾病(DN)的临床疗效。方法将80例早中期DN患者随机分为治疗组45例、对照组35例,两组患者均口服奥美沙坦脂。治疗组在此基础上加服雷公藤多甙。观察两组患者治疗前后尿白蛋白排泄率(UAER)、尿β2微球蛋白(β2-MG)、单核细胞趋化因子(MCP-1)、血清白蛋白(ALB)、血肌酐(SCr)和谷丙转氨酶(ALT)等指标变化。结果治疗组的总有效率为84.44%,对照组的总有效率为54.29%,治疗组的疗效较对照组好,差异有统计学意义(P<0.01)。治疗后两组UAER、β2-MG和MCP-1水平较治疗前出现明显下降(P<0.05或<0.01),但治疗组下降更为明显,与对照组比较差异有统计学意义(P<0.01)。仅治疗组SCr较治疗前和对照组出现明显下降(P<0.01),而治疗组ALB水平较对照组和治疗前出现明显提高,差异有统计学意义(P<0.01)。两组治疗前后的ALT水平差异无统计学意义(P>0.05)。结论雷公藤多甙联合奥美沙坦酯治疗DN疗效显著,其机理可能与降低MCP-1水平有关,并且毒副作用较小。
Objective To observe the clinical efficacy of tripterygium glycosides in the treatment of early-stage diabetic nephropathy (DN). Methods Eighty patients with early-to-mid stage DN were randomly divided into treatment group (n = 45) and control group (n = 35). Both groups were given oral olmesartan. On the basis of the treatment group, add tripterygium glycosides. Urinary albumin excretion rate (UAER), urinary β2 microglobulin (MCP), monocyte chemoattractant protein (MCP-1), serum creatinine (SCr) And alanine aminotransferase (ALT) and other indicators change. Results The total effective rate was 84.44% in the treatment group and 54.29% in the control group. The curative effect of the treatment group was better than that of the control group (P <0.01). The levels of UAER, β2-MG and MCP-1 in the two groups after treatment were significantly lower than those before treatment (P <0.05 or <0.01), however, the decrease was more obvious in the treatment group, with significant difference compared with the control group ). Compared with the control group and the control group, SCr in the treatment group decreased significantly (P <0.01), while the ALB level in the treatment group was significantly higher than that in the control group and before treatment (P <0.01). There was no significant difference in ALT levels between the two groups before and after treatment (P> 0.05). Conclusion Tripterygium glycosides combined with olmesartan medoxomil treatment of DN significant effect, its mechanism may be associated with lower MCP-1 levels, and fewer side effects.