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目的:探讨安体舒通联合骨化三醇治疗糖尿病肾病(DN)患者与单用安体舒通或骨化三醇在疗效、药物剂量的差异,研究联合用药治疗对DN患者尿蛋白、转化生长因子-β1(TGF-β1)等的影响。方法:以2013年8月至2014年8月肾内科收治的DN患者75例为研究对象,分为安体舒通组(A组)、骨化三醇组(B组)及联合用药组(C组),分别予以不同的用药方案,共治疗6个月。结果:C组用药剂量最少,总有效率最高(92.0%);C组副作用明显低于A组,与B组相近;B组的Scr、UAER明显高于A组和C组(P均<0.05)。三组的TGF-β1、IL-6、TNF-α、CRP均有下降趋势,且C组下降明显低于A、B组(P均<0.05)。结论:安体舒通联合骨化三醇治疗DN的疗效好,可明显减少单药剂量的使用,比起单独用药副作用更少;可显著改善患者的肾功能和尿蛋白,降低炎性因子水平,延缓肾纤维化的进程,考虑可能与两种药物同时降低了TGF-β1的表达有关。
Objective: To investigate the efficacy and dosage of spironolactone or calcitriol alone in patients with diabetic nephropathy (DN) treated with spironolactone combined with calcitriol, to study the effect of combination therapy on urinary protein in patients with DN, Growth factor-β1 (TGF-β1) and so on. Methods: Seventy-five patients with DN who were admitted to Department of Nephrology from August 2013 to August 2014 were enrolled in this study. Patients were divided into spironolactone group (A group), calcitriol group (B group) and combination group Group C), were given different drug regimens, a total of 6 months treatment. Results: The group C had the least dose and the highest total effective rate (92.0%). The side effects in group C were significantly lower than those in group A, which were similar to those in group B. The Scr and UAER in group B were significantly higher than those in group A and C ). The levels of TGF-β1, IL-6, TNF-α and CRP in the three groups showed a decreasing trend, and the decrease in group C was significantly lower than that in group A and B (all P <0.05). Conclusion: Spironolactone combined calcitriol treatment of DN good curative effect, can significantly reduce the use of single dose, compared with the side effects of medication alone; can significantly improve the patient’s renal function and urinary protein, reduce the level of inflammatory cytokines , Delay the process of renal fibrosis, consider the possibility of both drugs and reduce the expression of TGF-β1.