目的 探讨前列地尔联合血管紧张素Ⅱ受体阻滞剂(ARB)治疗糖尿病肾病的临床疗效,分析影响临床疗效的相关因素.方法 我院88例诊断为糖尿病肾病患者,随机分为两组:ARB组(48例),单纯给予ARB类药物以控制血压及改善肾功能;前列地尔联合ARB组(40例),给予ARB类药物的同时,给予静脉注射前列地尔连续14天,每四周随访各项指标变化,并根据临床效果运用Logistic回归分析可能的影响因素.结果 两组患者在随访至8周时,蛋白尿及肾功能均明显改善;相比ARB组,前列地尔联合ARB治疗能更快(4周时显示有差异P<0.05)、更好的改善患者肾功能及降低尿蛋白的排泄(P<0.05);Logistic回归分析显示,治疗前尿蛋白定量水平及是否应用前列地尔是影响治疗疗效的主要因素(P<0.05).结论 前列地尔联合血管紧张素Ⅱ受体阻滞剂能明显降低糖尿病肾病患者蛋白尿,改善肾功能;在控制血糖、血压、血脂稳定的基础上,治疗前尿蛋白定量水平及是否应用前列地尔是影响患者疗效的主要因素.%Objective: To analyze the efficacy of alprostadil combined angiotensin II receptor blocker in ( ARB ) treatment of diabetic nephropathy and analyze possible risk factors affecting the clinical efficacy. Method: In our hospital, 88 patients diagnosed as diabetic nephropathy were randomly divided into two groups : ARB group ( 48 patients ), ARB was given to control blood pressure and improve renal function; alprostadil combined ARB group ( 40 patients ), while ARB was given, alprostadil was given for 14 consecutive days by intravenous injection. Some indexes were compared between two groups. The possible effect factors were analyzed by Logistic regression analysis. Result: After 8 weeks of treatment, all patients in two groups, proteinuria and renal function were significantly improved; while compared to the ARB group, alprostadil combined ARB therapy can faster ( 4 weeks showed that the difference P <0. 05 ), better to improve patients with reduced renal function and urinary protein excretion ( P <0. 05 ); Logistic regression analysis showed that pre-treatment urinary protein levels and the use of alprostadil is the main factors affecting the treatment efficacy ( P <0. 05 ). Conclusion: Alprostadil combined angiotensin Ⅱ receptor blocker can significantly reduce proteinuria and improve renal function in patients with diabetic nephropathy. The pre-treatment urinary protein levels and the application of alprostadil is main factors of affecting outcomes.
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