前列地尔治疗慢性肾衰竭的疗效及其机制研究

摘要

目的 观察前列地尔治疗慢性肾衰竭的疗效,探讨其延缓慢性肾衰竭进展的机制.方法 选择我院慢性肾衰竭患者40例,随机分为治疗组和对照组各20例,对照组给予常规治疗,治疗组在常规治疗基础上给予前列地尔10 μg静脉滴注,1次/d,两组均治疗14 d.治疗前后测定两组患者肾功能指标(血肌酐、尿素氮、内生肌酐清除率)、24 h尿蛋白定量、肾血流动力学指标(肾动脉内径、叶间动脉阻力指数)、血液流变学指标(全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数、红细胞变形指数、血细胞比容)、纤维化指标(透明质酸、Ⅲ型前胶原肽、Ⅳ型胶原、层粘连蛋白).结果 治疗前两组患者的血肌酐、尿素氮、内生肌酐清除率、24 h尿蛋白定量、肾动脉内径、叶间动脉阻力指数、全血高切黏度、全血低切黏度、血浆黏度、红细胞聚集指数、红细胞变形指数、血细胞比容、透明质酸、Ⅲ型前胶原肽、Ⅳ型胶原、层粘连蛋白比较,差异均无统计学意义(P＞0.05);治疗后两组患者的上述指标比较,差异均有统计学意义(P＜0.05).结论 前列地尔可改善慢性肾衰竭患者的肾功能,其机制可能与改善肾血流动力学和血液流变学、减少尿蛋白、抗肾纤维化等有关,能有效延缓慢性肾衰竭的进展.%Objective To observe the efficacy of alprostadil in treating the chronic renal failure ( CRF ) and to explore the mechanism for delaying the progression of chronic renal failure. Methods Totally 40 CRF patients were randomly divided into treatment group ( n = 20 ) and control group ( n = 20 ), The control group received conventional therapy, The treatment group, on the basis of conventional therapy, received alprostadil 10 μg intravenous infusion, q. d. . Both two groups were treated for 14 days. Renal function parameters ( serum creatinine, blood urea nitrogen, and creatinine clearance rate ), 24 - hour urinary protein excretion, renal hemodynamics ( inner diameter of the renal artery and interlobar arterial resistance index ), hemorheology ( high shear viscosity of whole blood, low shear viscosity of whole blood, plasma viscosity, erythrocyte aggregation index, eryth-rocyte deformation index, and hematocrit ), fibrosis ( hyaluronic acid, procollagen type Ⅲ , type Ⅳ collagen, and laminin ) were detected before and after treatment. Results Before treatment, serum creatinine, blood urea nitrogen, creatinine clearance rate, 24 - hour urinary protein excretion, inner diameter of the renal artery, interlobar arterial resistance index, high shear viscosity of whole blood, low shear viscosity of whole blood, plasma viscosity, erythrocyte aggregation index, erythrocyte deformation index, hematocrit, hyaluronic acid, procollagen type Ⅲ , type Ⅳ collagen, and laminin showed no significant difference between the two groups ( P > 0. 05 ). After treatment, all these parameters were significantly different between these two groups ( P <0. 05 ). Conclusion Alprostadil can improve renal function in CRF patients by improving renal hemodynamics and hemorheology and reducing urinary protein and renal fibrosis.