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目的探讨盐酸特拉唑嗪联合甲钴胺对糖尿病神经源性膀胱患者的疗效及机制。方法将湖州市中心医院2015年3月—2016年6月收治的90例糖尿病神经源性膀胱患者随机分为2组,每组45例。对照组予α-硫辛酸治疗;治疗组在α-硫辛酸基础上予盐酸特拉唑嗪联合甲钴胺治疗。干预前后采血测定血清氧化应激指标、神经活性指标、早期肾损伤指标,进行尿动力学分析,同时对比临床疗效及不良反应状况。结果治疗组的有效率为88.89%,显著高于对照组的71.11%(P<0.05)。干预后治疗组最大尿流率、最大尿流率时逼尿肌压力、谷胱甘肽(GSH)、超氧化物歧化酶(SOD)、脑源性神经营养因子(BDNF)显著升高,且明显高于对照组(P<0.05)。干预后治疗组膀胱残余尿量、膀胱最大测压容量、血清活性氧(ROS)、丙二醛(MDA)、P物质(SP)、神经肽Y(NPY)、胱抑素C(CysC)、γ-谷氨酰转移酶(γ-GT)显著降低,且明显低于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论盐酸特拉唑嗪联合甲钴胺对糖尿病神经源性膀胱患者疗效确切,降低血清CysC、γ-GT水平,改善氧化应激和神经活性指标,安全性高。
Objective To investigate the efficacy and mechanism of terazosin hydrochloride combined with mecobalamin in patients with diabetic neurogenic bladder. Methods Ninety patients with diabetic neurogenic bladder admitted from March 2015 to June 2016 in Huzhou Central Hospital were randomly divided into two groups (45 cases in each group). The control group was treated with α-lipoic acid; the treatment group was treated with terazosin hydrochloride and mecobalamin on the basis of α-lipoic acid. Blood samples were taken before and after the intervention to determine serum oxidative stress index, neurological activity index and early renal damage index, and to analyze the urodynamic results. At the same time, the clinical efficacy and adverse reactions were compared. Results The effective rate of the treatment group was 88.89%, which was significantly higher than that of the control group (71.11%, P <0.05). In the treatment group, the maximum urinary flow rate, the detrusor pressure, glutathione (GSH), superoxide dismutase (SOD) and brain-derived neurotrophic factor (BDNF) in the treatment group were significantly increased Significantly higher than the control group (P <0.05). After treatment, the residual urinary bladder volume, the maximal manometry capacity of bladder, serum reactive oxygen species (ROS), malondialdehyde (MDA), substance P (SP), neuropeptide Y (NPY), cystatin C (CysC) γ-glutamyl transferase (γ-GT) was significantly lower, and significantly lower than the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion Terazosin hydrochloride combined with mecobalamin has definite therapeutic effect on patients with neurogenic bladder of diabetes mellitus, lowers the level of CysC and γ-GT, improves the indexes of oxidative stress and neuroactivity, and has high safety.