阿法骨化醇联合氯沙坦治疗早期糖尿病肾病疗效观察

摘要

目的：观察阿法骨化醇联合氯沙坦治疗早期糖尿病肾病的临床疗效。方法60例符合早期糖尿病肾病诊断标准的患者按照就诊顺序随机分为两组，所有入组患者均予以常规糖尿病治疗，对照组在常规治疗基础上口服氯沙坦；观察组在对照组基础上联合口服阿法骨化醇，疗程8周。观察各组患者治疗前后血清白蛋白（Alb）、肌酐（Scr）、糖化血红蛋白（HbA1c）、超敏C 反应蛋白（hs-CRP）、尿微量白蛋白肌酐比值（U-mALb/Ucr）、尿β2微球蛋白（U-β2-MG）等指标变化。结果经过8周治疗后观察，两组患者血清Scr、HbA1c与治疗前比较差异无统计学意义（P>0.05），对照组血清Alb、hs-CRP与治疗前比较差异无统计学意义（P>0.05），U-mALb/Ucr、U-β2-MG比治疗前下降，差异有统计学意义（P<0.05），观察组血清Alb比治疗前明显上升，血清hs-CRP、U-mALb/Ucr、U-β2-MG比治疗前明显下降，差异均有统计学意义（P<0.05），且与对照组比较差异有统计学意义（P<0.05）。结论应用阿法骨化醇联合氯沙坦治疗，可有效减少早期糖尿病肾病患者蛋白尿并提高血清白蛋白水平，其机制可能与联合用药加强抑制炎症反应及抑制肾素-血管紧张素-醛固酮（RASS）系统作用有关，且对肾功能和血糖无不良影响。%Objective To investigate the effect of combined therapy with alfacalcidol and losartan on the diabetic nephropathy in early stage. Methods The 60 diabetic nephropathy patients were randomly divided into two groups according to the doctor order. All Patients were treated with conventional treatment,patients in control group were treated with losartan on base of conventional treatment,meanwhile,patients in observation group were treated with alfacalcidol on base of control group .Albumin(ALB),serum creatinine(Scr),Glycated hemoglobin(HbAlc), hypersensitive C-reactive(hs-CRP),Urinary albumin creatinine ratio(U-mALb/Ucr),beta-2 microglobulin(β2-MG)were observed and compared before and 8 weeks after treatment. Results After 8 weeks treatment,the level of Scr and HbAlc compared with those before treatment,the difference were not statistically significant(P>0.05). The level of Alb and hs-CRP of the control group were not changed significantly compared with those before treatment(P>0.05). The level of U-mALb/Ucr and β2-MG were decreased,compared with those before treatment,the difference were statistically significant(P<0.05). The level of Alb of the control group were higher,while the level of hs-CRP,U-mALb/Ucr and β2-MG were lower than those before treatment,the difference were statistically significant(P<0.05),and that there were statistically significant compared with those before treatment(P<0.05). Conclusion Combined therapy with alfacalcidol and losartan can reduce the urine protein excretion and increase the levels of ALB. The mechanism may be related to combination strengthening inhibit inflammatory reaction and inhibit aldosterone renin - angiotensin -(RASS) system function,and there is no adverse effect on renal function and blood sugar.