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目的观察低分子肝素联合血管转换酶抑制剂对糖尿病肾病显性蛋白尿的治疗效果。方法将64例糖尿病肾病显性蛋白尿患者随机分为A、B、C3组。A组常规降血糖和饮食控制及对症治疗;B组在A组的基础上加用低分子肝素2500U皮下注射,2次/d;C组在A组的基础上加用洛汀新10mg口服,2次/d;D组在A组的基础上加用低分子肝素2500U皮下注射,2次/d,同时给予洛汀新10mg口服,2次/d。观察治疗前后24h尿蛋白定量、血清白蛋白(ALB)、血肌酐(Scr)、内生肌酐清除率(Ccr)的变化。结果A组病情改善不明显,部分病例有不同程度的恶化;B组及C组24h蛋白尿定量均有明显下降、ALB明显升高,Ccr有轻度下降,但不明显。D组24h蛋白尿明显下降,ALB及Ccr均明显升高。结论低分子肝素联合血管转换酶抑制剂对糖尿病肾病显性蛋白尿的治疗有明显效果,且优于单用LMWH或单用血管转换酶抑制剂。
Objective To observe the therapeutic effect of low molecular weight heparin and angiotensin converting enzyme inhibitors on the apparent proteinuria in diabetic nephropathy. Methods 64 patients with diabetic nephropathy dominant proteinuria were randomly divided into A, B and C3 groups. A group of conventional hypoglycemic and diet control and symptomatic treatment; B group in group A based on the use of low molecular weight heparin 2500U subcutaneous injection, 2 times / d; C group on the basis of group A with Lotensin 10mg orally, 2 times / d. Group D was subcutaneously injected with low molecular weight heparin 2500U subcutaneously twice a day on the basis of group A, while oral administration of Lotensin 10mg orally twice daily. The changes of urinary protein, serum albumin (ALB), serum creatinine (Scr) and endogenous creatinine clearance (Ccr) were observed before and after treatment. Results The disease in group A was not improved obviously, and some cases were exacerbated to some extent. The proteinuria of 24h in group B and C were significantly decreased, ALB was significantly increased, and Ccr was slightly decreased, but not obvious. 24h proteinuria in group D decreased significantly, ALB and Ccr were significantly increased. Conclusion Low molecular weight heparin combined with angiotensin converting enzyme inhibitor has obvious effect on the treatment of dominant proteinuria in diabetic nephropathy, and is superior to single LMWH or angiotensin converting enzyme inhibitor alone.