雷公藤多苷治疗糖尿病肾病Ⅲ期疗效分析

摘要

Objective To investigate the effects of triptolide on diabetic nephropathy (DN).Methods Seventy-five patients of type 2 diabetes with DN of Ⅲ stage were randomized into two groups.Fourty patients in treatment group received triptolide 60 mg/d and losartan 100 mg/d,while the other 35 patients in control group received losartan 100 mg/d; with a course of 12 weeks in each group.The levels of 24 h urine albumin,laminin (LN),ⅣV-collagen(C-Ⅳ),high sensitive C-creative protein (hsCRP) and urinary podocytes were measured before and after the treatments.Results After 12 weeks of treatment,the levels of 24h urine albumin,LN,C-Ⅳ,hsCRP,and urinary podocytes in two groups decreased significantly (P ＜ 0.05) ; the level of LN and hsCRP in treatment group decreased more than that in control group(P ＞0.05) ; the level of 24 h urine albumin,C-Ⅳ and urinary podocytes in treatment group decreased more significantly than that in control group (P ＜ 0.05).No serious adverse reactions occurred in both groups.Conclusions Triptolide may decrease the amount of proteinuria of diabetic nephropathy and in DN developing.The mechanism appears to be related with suppressing expressions of inflammatory cytokines.%目的 观察雷公藤多苷治疗糖尿病肾病(DN)Ⅲ期的疗效.方法 75例2型糖尿病并DNⅢ期患者,完全随机分为观察组(40例)和对照组(35例).观察组予以雷公藤多苷60 mg/d及氯沙坦100 mg/d,对照组给予氯沙坦100 mg/d,总疗程12周.治疗前后进行24h尿微量白蛋白(24 h Alb)、层黏连蛋白(LN)、Ⅳ型胶原(C-Ⅳ)、血浆高敏C反应蛋白(hs-CRP)的定量测定及尿中足细胞计数.结果 治疗后2组24 h Alb、尿中足细胞计数、LN、C-Ⅳ、hs-CRP均明显下降[对照组:(117±30) mg比(173±35) mg,(1.2±0.6)个/ml比(1.7±0.8)个/ml,(127±25) μg比(144±26) μg,(248±25)μg比(274±27) μg,(4.3±1.4) mg/L比(5.0±1.7) mg/L；观察组:(104±20)mg比(169±27) mg,(1.1±0.4)个/ml比(1.8±0.7)个/ml,(125±27)μg比(145±28) μg,(253±74) μg比(282±74) μg,(3.8±1.2) mg/L比(4.9±1.7)mg/L,均P＜0.05],且观察组下降更明显,其中24 h Alb、尿足细胞计数及C-Ⅳ减少差异具有统计学意义(均P＜0.05)；2组均无严重不良反应发生.结论 雷公藤多苷可以减少DNⅢ期患者尿微量白蛋白及足细胞的凋亡,炎症因子在DN的发生发展中起重要的作用.