摘要
目的:探讨双重肾素-血管紧张素系统(RAS)阻断在1~3a期糖尿病肾病中的应用效果。方法:选取2019年1月-2022年1月武威市中医医院收治的86例1~3a期糖尿病肾病患者,使用随机数字表法将其分为观察组(n=43)及对照组(n=43)。对照组接受单重紧张素系统阻断[血管紧张素Ⅱ受体拮抗剂(ARB)]治疗,观察组接受双重RAS阻断治疗[血管紧张素转换酶抑制(ACEI)联合ARB]治疗。比较两组肾功能指标、糖代谢指标、炎症因子指标及多聚ADP核糖聚合酶(PARP)与3-磷酸甘油脱氢酶(GAPDH)活性。结果:治疗前,两组尿素氮(BUN)、血肌酐(Scr)及肾小球滤过率(eGFR)水平比较,差异均无统计学意义(P>0.05);治疗后,两组BUN及Scr水平均较治疗前降低,观察组均低于对照组;eGFR均较治疗前升高,观察组高于对照组(P<0.05)。治疗前,两组空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、单核细胞趋化蛋白-1(MCP-1)、转化生长因子-β1(TGF-β1)及肿瘤坏死因子-α(TNF-α)水平比较,差异均无统计学意义(P>0.05);治疗后,两组FPG、2 h PG、HbA1c、FINS、HOMA-IR、MCP-1、TGF-β1、TNF-α均较治疗前降低,观察组均低于对照组(P<0.05)。治疗前,两组PARP与GAPDH比较,差异均无统计学意义(P>0.05);治疗后,两组的PARP均较治疗前降低,观察组低于对照组;GAPDH均较治疗前上升,观察组高于对照组(P<0.05)。结论:双重RAS阻断可改善1~3a期糖尿病肾病患者的肾功能、减轻炎症反应,调节PARP与GAPDH活性,改善糖代谢,效果优异。
Objective:To investigate the effect of dual renin-angiotensin system(RAS)blockade in the treatment of stage 1-3a diabetic nephropathy.Method:A total of 86 patients with stage 1-3a diabetic nephropathy admitted to Wuwei Hospital of Traditional Chinese Medicine from January 2019 to January 2022 were selected,they were divided into observation group(n=43)and control group(n=43)according to the random number table method.The control group received single angiotensin system blockade[angiotensin receptorⅡantagonist(ARB)]and the observation group received dual RAS blockade[angiotensin-converting enzyme inhibition(ACEI)combined with ARB].The renal function indexes,glucose metabolism indexes,inflammatory factor indexes and poly ADP ribose polymerase(PARP)and 3-phosphoglycerol dehydrogenase(GAPDH)activities of the two groups were compared.Result:Before treatment,there were no significant differences in the levels of blood urea nitrogen(BUN),blood creatinine(Scr)and glomerular filtration rate(eGFR)between the two groups(P>0.05);after treatment,the levels of BUN and Scr in both groups were lower than those before treatment,those in the observation group were lower than those in the control group;eGFR were higher than those before treatment,that in the observation group was higher than that in the control group(P<0.05).Before treatment,there were no significant differences in fasting plasma glucose(FPG),2 h postprandial glucose(2 h PG),glycated hemoglobin(HbA1c),fasting insulin(FINS),insulin resistance index(HOMA-IR),monocyte chemotactic protein-1(MCP-1),transforming growth factor-β1(TGF-β1)and tumor necrosis factor-α(TNF-α)levels between the two groups(P>0.05);after treatment,FPG,2 h PG,HbA1c,FINS,HOMA-IR,MCP-1,TGF-β1 and TNF-αin both groups were reduced compared with those before treatment,those in observation group were lower than those in control group(P<0.05).Before treatment,there were no significant differences in PARP and GAPDH between the two groups(P>0.05);after treatment,PARP in both groups were lower than those before treatment,that in observation group was lower than that in control group,GAPDH in both groups were higher than those before treatment,that in observation group was higher than that in control group(P<0.05).Conclusion:Dual RAS blockade can improve renal function,reduce inflammatory response,regulate PARP and GAPDH activities,and improve glucose metabolism in diabetic nephropathy patients with chronic kidney disease stage 1-3a with excellent effects.
作者
陈丽萍
CHEN Liping(Wuwei Hospital of Traditional Chinese Medicine,Gansu Province,Wuwei 733000,China)
出处
《中国医学创新》
CAS
2023年第15期21-25,共5页
Medical Innovation of China
基金
武威市2020年度第一批市列科技计划项目(WW2001026)。
