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目的探讨厄贝沙坦联合阿卡波糖治疗早期糖尿病肾病的临床疗效,观察药物对患者糖代谢指标、蛋白尿指标及血清中炎症因子指标的影响。方法选取增城区永宁街宁西社区卫生服务中心2014年10月-2016年10月接诊的早期糖尿病肾病患者152例,随机分为对照组和治疗组,各76例。对照组患者给予阿卡波糖治疗,治疗组在此基础上给予厄贝沙坦治疗,两组患者均以4周为1个疗程,连续治疗3个疗程。观察测定并记录两组患者治疗前后糖代谢指标、蛋白尿指标及血清中炎症因子的改变。结果治疗组患者的临床总有效率为94.74%明显高于对照组的76.32%,差异有统计学意义(P<0.05)。治疗前,两组患者的空腹血糖及糖化血红蛋白值无明显差异(P>0.05);治疗后,两组患者的空腹血糖及糖化血红蛋白值均低于本组治疗前,并且治疗组患者经过治疗后空腹血糖及糖化血红蛋白值均低于对照组,差异有统计学意义(P<0.05)。治疗前,所有患者的尿微量白蛋白以及排泄率值无明显差异(P>0.05);治疗后,两组患者的尿微量白蛋白以及排泄率值均较本组治疗前有明显降低,但治疗组的两项指标与对照组相比有显著的降低,差异有统计学意义(P<0.05)。治疗前,所有患者血清中单核细胞趋化蛋白-1(MCP-1)、血清高敏C反应蛋白(hs-CRP)及可溶性细胞间黏附分子-1(sICAM-1)含量无明显差异(P>0.05);治疗后,两组患者经过血清中MCP-1、hs-CRP及sICAM-1含量较本组治疗前均有明显降低,并且治疗组患者经过治疗,血清中MCP-1、hs-CRP及sICAM-1含量比对照组患者有显著的降低,差异有统计学意义(P<0.05)。结论厄贝沙坦联合阿卡波糖对早期糖尿病肾病的治疗具有显著的效果,患者的蛋白尿指标、肾血流参数及血清中炎症因子指标均有显著的改善,疗效肯定。
Objective To investigate the clinical efficacy of irbesartan combined with acarbose in the treatment of early diabetic nephropathy, and to observe the effects of drugs on indexes of glycometabolism, proteinuria and serum inflammatory cytokines in patients. Methods A total of 152 early diabetic nephropathy patients admitted to Ningxi Community Health Service Center of Yongning Street from October 2014 to October 2016 were randomly divided into control group and treatment group, with 76 cases in each. Patients in the control group were treated with acarbose. The treatment group was treated with irbesartan on the basis of this treatment. Two groups of patients were treated with one course of treatment for 4 weeks and three courses of continuous treatment. The changes of glucose metabolism index, proteinuria index and serum inflammatory factors before and after treatment were observed and recorded. Results The total clinical effective rate of the treatment group was 94.74%, which was significantly higher than that of the control group (76.32%), the difference was statistically significant (P <0.05). Before treatment, there was no significant difference in fasting blood glucose and glycosylated hemoglobin between the two groups (P> 0.05). After treatment, the fasting blood glucose and HbA1c in both groups were lower than before treatment, and after treatment, Fasting blood glucose and glycosylated hemoglobin values were lower than the control group, the difference was statistically significant (P <0.05). Before treatment, all patients had no significant differences in urinary albumin and excretion rate (P> 0.05); after treatment, urinary albumin and excretion rate in both groups were significantly lower than those before treatment, but treatment Two indicators of the group compared with the control group were significantly lower, the difference was statistically significant (P <0.05). Before treatment, the levels of monocyte chemoattractant protein-1 (MCP-1), serum hs-CRP and sICAM-1 in serum of all patients had no significant difference (P > 0.05). After treatment, the levels of MCP-1, hs-CRP and sICAM-1 in serum of the two groups were significantly lower than those before treatment in both groups, and the treatment group patients after treatment, serum MCP-1, hs- CRP and sICAM-1 levels were significantly lower than those in the control group, the difference was statistically significant (P <0.05). Conclusion Irbesartan combined with acarbose has a significant effect on the treatment of early diabetic nephropathy. The proteinuria index, renal blood flow parameters and serum inflammatory cytokines were significantly improved in patients with definite curative effect.