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目的:观察普罗布考联合奥美沙坦酯对糖尿病肾病Ⅲ期的疗效。方法:将78例患者随机分为奥美沙坦酯组(A组)26例、普罗布考组(B组)26例及普罗布考联合奥美沙坦酯组(C组)26例。A组在常规降糖治疗的基础上加用奥美沙坦酯片20mg/次,每日1次,B组在常规降糖治疗的基础上加用普罗布考500mg/次,每日2次,C组在常规降糖治疗的基础上加用奥美沙坦酯片20mg/次,每日1次,普罗布考500mg/次,每日2次。疗程12周,检测3组患者治疗前后尿微量白蛋白排泄率(UAER)、24h尿蛋白定量(24hUAlb)、肾功能(BUN、SCr、cys-C)、血脂(TC、TG、LDL、HDL)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、血清超敏C反应蛋白(hs-CRP)、氧化型低密度脂蛋白(ox-LDL)、肝功能(ALT、AST),监测血压并作统计学分析。结果:①3组患者治疗前各观察指标差异无统计学意义(P>0.05)。②治疗12周后组内比较,A组与治疗前比较,UAER、24hUAlb、hs-CRP、ox-LDL、SBP、DBP水平下降(P<0.05或P<0.01);B组与治疗前比较,UAER、24hUAlb、hs-CRP、ox-LDL、TC、TG、LDL水平明显下降(P<0.01),HDL升高(P<0.05);C组与治疗前比较,UAER、24hUAlb、hs-CRP、ox-LDL、TC、TG、LDL、SBP、DBP水平下降(P<0.05或P<0.01),HDL升高(P<0.05)。③治疗12周后组间比较,A、B组比较,UAER、24hUAlb差异无统计学意义(P>0.05),A组SBP、DBP较B组下降(P<0.05),B组与A组比较,TC、TG、LDL水平明显下降(P<0.05或P<0.01),HDL升高(P<0.05),hs-CRP、ox-LDL下降更明显(P<0.05);C组与A、B两组比较,UAER、24hUAlb、hs-CRP、ox-LDL显著下降(P<0.01)。结论:奥美沙坦酯及普罗布考均能有效降低Ⅲ期糖尿病肾病患者UAER、24hUAlb、hs-CRP、ox-LDL;普罗布考在发挥调脂作用的同时,联合奥美沙坦酯可更显著降低Ⅲ期糖尿病肾病患者蛋白尿、炎症与氧化应激水平,有协同作用,能更好地保护肾脏。
Objective: To observe the effect of probucol combined with olmesartan medoxomil on stage Ⅲ of diabetic nephropathy. Methods: Totally 78 patients were randomly divided into two groups: 26 patients in the olmesartan medoxomil group (A group), 26 in the probucol group (B group), and 26 in the probucol combined with the olmesartan medoxomil group (C group). Group A was treated with olmesartan 20 mg once daily on the basis of routine hypoglycemic treatment, group B was given probucol 500 mg twice daily on the basis of conventional hypoglycemic therapy, C group in the usual hypoglycemic treatment based on the use of olmesartan 20 mg / times, once daily, probucol 500mg / times, 2 times a day. After treatment for 12 weeks, the urinary albumin excretion rate (UAER), 24h urinary protein (24hUAlb), renal function (BUN, SCr, cys-C), blood lipid (TC, TG, LDL, HDL) , Fasting blood glucose (FBG), HbA1c, hs-CRP, ox-LDL, liver function (ALT, AST) Analysis. Results: ① There was no significant difference between the three groups before treatment (P> 0.05). ② After 12 weeks of treatment, the levels of UAER, 24hUAlb, hs-CRP, ox-LDL, SBP and DBP in group A decreased compared with those before treatment in group A (P <0.05 or P <0.01) The levels of UAER, 24hUAlb, hs-CRP, ox-LDL, TC, TG and LDL were significantly decreased (P <0.01) The levels of ox-LDL, TC, TG, LDL, SBP, DBP decreased (P <0.05 or P <0.01) and HDL increased (P <0.05). ③ After 12 weeks of treatment, there was no significant difference between UAER and 24hUAlb in group A and group B (P> 0.05). The SBP and DBP in group A were lower than those in group B (P <0.05) (P <0.05 or P <0.01), HDL increased (P <0.05), hs-CRP and ox-LDL decreased significantly (P <0.05) The levels of UAER, 24hUAlb, hs-CRP and ox-LDL decreased significantly in both groups (P <0.01). Conclusion: Both olmesartan medoxomil and probucol can effectively reduce UAER, 24hUAlb, hs-CRP and ox-LDL in patients with stage III diabetic nephropathy. Probucol can play a more important role in the regulation of lipid metabolism and olmesartan Reduce proteinuria in patients with stage III diabetic nephropathy, inflammation and oxidative stress, have a synergistic effect, can better protect the kidneys.