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目的探讨复方α-酮酸(开同)片治疗早期糖尿病肾病患者对其颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)的影响。方法将80例早期糖尿病肾病患者随机分为对照组(42例)和治疗组(38例)。对照组常规治疗,包括低蛋白饮食,治疗组在常规治疗的基础上进行复方α-酮酸(开同)片干预性治疗,疗程均为6个月。两组治疗前后进行体格检查,空腹抽静脉血,测定血尿酸(UA)、空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、胰岛素(FINS),测定CIMT和尿微量白蛋白排泄率(urinary micro albumen excretion rate,UAER)。结果治疗前两组患者各指标差异无统计学意义。治疗6个月后,治疗组患者FINS、稳态模型胰岛素抵抗指数(Homa-IR)、lnUAER、CIMT与治疗前及对照组治疗6个月后比较均明显下降(P<0.05);治疗组治疗前后CIMT差值大于对照组,差异有统计学意义(P<0.05)。通过协方差分析调整治疗组治疗前后血脂、血糖变化,治疗6个月后与治疗前比较,Homa-IR(F=2.60)、lnUAER(F=3.15)、CIMT(F=3.94)的差异仍然有统计学意义(P<0.05,P<0.01);治疗组治疗前后CIMT差值大于对照组(F=5.51)。结论复方α-酮酸(开同)片能有效改善早期糖尿病肾病患者胰岛素抵抗,长期治疗可降低微量白蛋白尿,并能减缓或阻止动脉粥样硬化的进展。
Objective To investigate the effect of compound α-ketoacid (KT) tablet on carotid intima-media thickness (CIMT) in patients with early stage diabetic nephropathy. Methods Eighty patients with early diabetic nephropathy were randomly divided into control group (n = 42) and treatment group (n = 38). Control group conventional treatment, including low-protein diet, the treatment group on the basis of conventional treatment of compound α-keto acid (open the same) piece of interventional treatment, treatment were 6 months. Before and after treatment, the physical examination, fasting venous blood, blood urea nitrogen (UA), fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), Insulin (FINS), CIMT and urinary microalbumin excretion rate (UAER). Results There was no significant difference between the two groups before treatment. The levels of FINS, Homa-IR, lnUAER and CIMT in the treatment group were significantly decreased 6 months after treatment (P <0.05) after 6 months of treatment. The treatment group Before and after CIMT difference is greater than the control group, the difference was statistically significant (P <0.05). The changes of blood lipid and blood glucose before and after treatment in the treatment group were adjusted by covariance analysis. The differences of Homa-IR (F = 2.60), lnUAER (F = 3.15) and CIMT (F = 3.94) still remained after 6 months of treatment (P <0.05, P <0.01). The difference of CIMT before and after treatment in the treatment group was greater than that in the control group (F = 5.51). Conclusion Compound α-ketoacid (KT) tablets can effectively improve insulin resistance in patients with early diabetic nephropathy. Long-term treatment can reduce microalbuminuria and slow or stop the progression of atherosclerosis.