摘要
目的观察阿托伐他汀钙联合缬沙坦治疗早期糖尿病肾病(DN)的临床效果并探讨可能的机制。方法选择明确诊断的早期DN 90例,随机分为两组,完成全部临床观察并记录完整的86例,其中对照组42例,治疗组44例。两组均予常规及缬沙坦(160 mg/d)治疗,治疗组在此基础上予阿托伐他汀钙(20 mg/d),疗程均为6个月。两组治疗前后均测定血压、血脂、肌酐(Cr)、尿素(BUN)、胱抑素C(Cys C)、视黄醇结合蛋白(RBP)和尿白蛋白排泄率(UAER),并进行比较。结果两组治疗后收缩压、舒张压和平均动脉压均较治疗前显著下降(P<0.01),组间比较差异无统计学意义(P>0.05);治疗组治疗后总胆固醇、甘油三酯、低密度脂蛋白胆固醇较治疗前显著下降(P<0.01),治疗组较对照组下降更显著(P<0.01);治疗组Cys C、RBP较治疗前明显下降(P<0.05),对照组Cys C、RBP较治疗前下降不明显(P>0.05),治疗后组间比较差异显著(P<0.05)。两组UAER均较治疗前显著下降(P<0.05,P<0.01),治疗组较对照组下降更明显(P<0.01)。两组Cr、BUN均较治疗前有所下降,但组间及组内治疗前后比较差异无统计学意义(P>0.05)。结论阿托伐他汀钙联合缬沙坦在降低血压和血脂的同时能有效降低UAER和Cys C、RBP水平,改善肾功能,延缓DN进程。
Objective To investigate clinical effect of atorvastatin combined with valsartan treatment in patients with early diabetic nephropathy（ DN） and its possible mechanisms. Methods 90 patients with definitive diagnosis of early DN were randomly divided into two groups,and 86 of them completed all the clinical experiments with complete records. Among them,42 cases were in control group and 44 cases were in treatment group. Both groups were given routine treatment and in addition the control group was given valsartan（ 160 mg / d）,while the treatment group was given valsartan（ 160 mg / d） and atorvastatin（ 20 mg / d） simultaneously,the treatment course was six months in both groups. Systolic blood pressure,diastolic blood pressure and mean arterial blood pressure,total cholesterol（ TC）,triglyceride（ TG） and low-density lipoprotein cholesterol（ LDL-C）,serum creatinine（ Cr）,blood urea nitrogen（ BUN）,serum cystatin C（ Cys-C） and retinol-binding protein（ RBP） and urinary albumin excretion rate（ UAER） were measured and compared before and after treatment in two groups.Results After six months＇ of treatment in two groups,systolic blood pressure,diastolic blood pressure and mean arterial pressure were significantly lower than that of baseline（ P〈0. 01）,but there were no differences between the two groups（ P〈0. 05）. After treatment,TC,TG and LDL-C in treatment group were significantly lower than that of baseline（ P〈0. 01）,their values were significantly lower than that of control group,too（ P〈0. 01）. Cys-C and RBP in treatment group significantly decreased（ P〈0. 05）,while Cys-C and RBP in control group had no statistical change（ P〈0. 05）,there were still differences between the two groups after treatment. UAER in both group was significantly reduced,compared with the baseline（ P〈0. 01）,while UAER in treatment group was lower than that of control group（ P〈0. 01）. Cr and BUN level in the two groups also had a slight decrease,but there was no significantl change in the two groups. Conclusion Atorvastatin with valsartan treatment in diabetic patients with nephropathy can reduce blood pressure and lipids effectively,and reduce Cys-C,RBP and UAER significantly,therefore it can obviously improve renal function and prevent the progress of diabetic nephropathy.
出处
《临床误诊误治》
2015年第12期91-95,共5页
Clinical Misdiagnosis & Mistherapy
基金
全军十一五课题军队计划免疫研究项目(04A)
