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目的:观察来氟米特联合氯沙坦对2型糖尿病肾病大量蛋白尿患者的疗效及对血清IL-1、IL-6及TNF-a的影响。方法:选取2011年12月至2013年8月在甘肃省人民医院、武威市人民医院及兰州大学第一医院肾内科住院的69例合并大量蛋白尿的2型糖尿病肾病患者,随机分为治疗组和对照组,治疗组35例,对照组34例。治疗组采用来氟米特联合氯沙坦治疗,对照组采用氯沙坦治疗。观察治疗前、第30天、60天患者24h尿蛋白定量、血浆白蛋白、血肌酐、尿素氮及谷丙转氨酶水平;检测患者治疗前、第30天血清IL-1、IL-6及TNF-a水平。结果:在用药30天后对照组尿蛋白轻度下降(P>0.05);治疗组尿蛋白明显下降(P<0.05);治疗60天后对照组尿蛋白轻度下降,治疗组尿蛋白明显下降(P<0.05)。治疗前两组患者血清IL-1、IL-6及TNF-a水平均较对照组明显升高,治疗30天后对照组IL-1、IL-6及TNF-a水平无改变,治疗组明显下降(P<0.05)。治疗30天及60天后两组谷丙转氨酶、血肌酐和尿素氮无明显改变。结论:氯沙坦对糖尿病肾病大量蛋白尿在治疗60天有轻度降低;来氟米特联合氯沙坦可以显著减轻尿蛋白,升高血浆白蛋白,且无肝脏损害;来氟米特联合氯沙坦可降低血清IL-1、IL-6及TNF-a水平,抗炎作用可能是降低糖尿病肾病大量蛋白尿的机制。
Objective: To observe the effect of leflunomide combined with losartan on the patients with massive proteinuria in type 2 diabetic nephropathy and its effect on serum IL-1, IL-6 and TNF-a. Methods: A total of 69 patients with Type 2 diabetic nephropathy with massive proteinuria hospitalized in Renmin Hospital of Gansu Province, Wuwei People’s Hospital and Lanzhou University First Hospital from December 2011 to August 2013 were randomly divided into treatment group And control group, 35 cases in the treatment group and 34 cases in the control group. The treatment group was treated with leflunomide and losartan, while the control group was treated with losartan. Serum levels of albumin, serum creatinine, urea nitrogen and alanine aminotransferase were measured before treatment, on the 30th day and 60th day respectively. The levels of IL-1, IL-6 and TNF- a level. Results: The urine protein of the control group decreased slightly (P> 0.05) 30 days after treatment; the proteinuria of the treatment group decreased significantly (P <0.05); the proteinuria of the control group decreased slightly after 60 days of treatment, <0.05). The serum levels of IL-1, IL-6 and TNF-a in the two groups before treatment were significantly higher than those in the control group. The level of IL-1, IL-6 and TNF-a did not change in the control group after 30 days of treatment, (P <0.05). After 30 days and 60 days treatment, alanine aminotransferase, serum creatinine and urea nitrogen in both groups showed no significant change. Conclusion: Losartan on diabetic nephropathy mass proteinuria slightly reduced 60 days after treatment; leflunomide combined with losartan can significantly reduce urinary protein, elevated plasma albumin, and no liver damage; leflunomide combined Losartan can reduce serum IL-1, IL-6 and TNF-a levels, anti-inflammatory effect may be to reduce the massive proteinuria in diabetic nephropathy mechanism.