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目的探讨糖尿病肾病患者应用普罗布考改善颈动脉内中膜厚度(intima-media thickness,IMT)的效果。方法85例糖尿病肾病患者随机分为普罗布考组42例和对照组43例,普罗布考组口服普罗布考,对照组口服安慰剂,均500mg/次,2次/d,服用24周后减量为250mg/次,2次/d,连续24周。分别于治疗前和治疗48周后行颈动脉超声检查测量2组颈动脉IMT;检测2组治疗前、后空腹血糖(fasting plasma glucose,FPG),血清糖化血红蛋白(hemoglobin A1c,HbA1c)、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白胆固醇(low density lipoproteincholesterol,LDL-C)、肌酐(serum creatinine,SCr),24h尿蛋白定量和估算的肾小球滤过率(estimated glomerular filtration rate,eGFR),并进行比较。结果 2组治疗前FPG、HbA1c、TC、TG、LDL-C、24h尿蛋白定量、SCr、eGFR及颈动脉IMT比较差异均无统计学意义(P>0.05);2组治疗48周后FPG、HbA1c、TG、24h尿蛋白定量、SCr和eGFR与治疗前比较差异均无统计学意义(P>0.05);普罗布考组治疗48周后TC[3.9(3.2,4.8)mmol/L]、LDL-C[2.1(1.6,2.8)mmol/L]和颈动脉IMT[1.0(0.9,1.2)mm]均低于治疗前[4.4(3.8,5.2)mmol/L、2.5(2.0,3.2)mmol/L、1.2(1.1,1.4)mm],且低于对照组治疗48周后[4.6(3.9,5.6)mmol/L、2.8(2.0,3.7)mmol/L、1.3(1.1,1.4)mm](P<0.05)。结论糖尿病肾病患者应用普罗布考治疗可降低血清TC和LDL-C,明显改善颈动脉IMT。
Objective To investigate the effect of probucol on carotid intima-media thickness (IMT) in patients with diabetic nephropathy. Methods A total of 85 patients with diabetic nephropathy were randomly divided into probucol group (n = 42) and control group (n = 43). Patients in probucol group were given probucol orally, while those in the control group were given placebo 500 mg twice daily after 24 weeks Reduction of 250mg / time, 2 times / d, for 24 weeks. The carotid IMT was measured in two groups before and 48 weeks after treatment. The fasting plasma glucose (FPG), serum hemoglobin A1c (HbA1c), total cholesterol (total cholesterol cholesterol, TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), serum creatinine (SCr), 24h urinary protein and estimated glomerular filtration rate (estimated glomerular filtration rate, eGFR), and compared. Results The levels of FPG, HbA1c, TC, TG, LDL-C, 24h urinary protein, SCr, eGFR and carotid artery IMT were not significantly different between the two groups before treatment (P> 0.05) HbA1c, TG, 24h urinary protein, SCr and eGFR were not significantly different from those before treatment (P> 0.05), and TC [3.9 (3.2,4.8) mmol / L] (2.1, 1.6, 2.8) mmol / L and carotid artery IMT (1.0, 0.9, 1.2) L, 1.2 (1.1, 1.4) mm] and lower than those in the control group after 48 weeks of treatment [4.6 (3.9,5.6) mmol / L, 2.8 P <0.05). Conclusion The application of probucol in diabetic nephropathy patients can reduce serum TC and LDL-C, significantly improve the carotid IMT.