摘要
目的探讨阿托伐他汀联合吲哚布芬治疗老年糖尿病肾脏病(DKD)合并大动脉粥样硬化型缺血性卒中(LAA-IS)恢复期的有效性和安全性。方法回顾性分析2018年9月至2022年4月保定市第二中心医院102例老年DKD合并LAA-IS恢复期患者的临床资料。其中,采用阿托伐他汀联合吲哚布芬治疗51例(观察组),阿托伐他汀联合阿司匹林治疗51例(对照组),均连续治疗6个月。比较两组治疗前后血栓前状态指标,包括花生四烯酸(AA)和二磷酸腺苷(ADP)诱导血小板聚集率、纤维蛋白原(FIB)、蛋白C;神经功能和日常生命质量,采用美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损情况,采用改良Barthel指数(MBI)评估日常生命质量;颈动脉超声指标,包括颈动脉内膜-中层厚度(IMT)和最大斑块面积;肾纤维化指标,包括转化生长因子-β1(TGF-β1)、基质金属蛋白酶-9(MMP-9)、透明质酸和血小板衍生生长因子-BB(PDGF-BB)。记录药物不良反应发生情况。结果两组治疗前各观察指标比较差异无统计学意义(P>0.05)。两组治疗后AA诱导血小板聚集率、ADP诱导血小板聚集率、FIB、NIHSS评分、IMT和最大斑块面积明显低于治疗前,蛋白C和MBI评分明显高于治疗前,差异有统计学意义(P<0.01);两组治疗后比较差异无统计学意义(P>0.05)。两组治疗后TGF-β1、MMP-9、透明质酸和PDGF-BB明显低于治疗前,且观察组明显低于对照组[(39.46±6.89)μg/L比(45.04±8.20)μg/L、(278.46±49.39)μg/L比(327.30±57.28)μg/L、(102.37±20.62)μg/L比(116.84±24.97)μg/L和(25.26±4.45)μg/L比(28.13±5.08)μg/L],差异有统计学意义(P<0.01)。观察组不良反应发生率明显低于对照组[7.84%(4/51)比23.53%(12/51)],差异有统计学意义(P<0.05)。结论与阿托伐他汀联合阿司匹林相比,老年DKD合并LAA-IS恢复期患者给予阿托伐他汀联合吲哚布芬在改善血栓前状态相关指标、减少神经功能缺损、提高日常生命质量、逆转颈动脉粥样硬化方面的效果相当,但阿托伐他汀联合吲哚布芬能进一步保护患者肾功能,安全性更高。
Objective To investigate the efficacy and safety of atorvastatin combined with indobufen in the treatment of elderly patients with diabetic kidney disease(DKD)complicated with large atheromatous ischemic stroke(LAA-IS)during convalescence.Methods The clinical data of 102 elderly patients with DKD complicated with LAA-IS during convalescence from September 2018 to April 2022 in Baoding Second Central Hospital were retrospectively analyzed.Among them,51 patients were treated with atorvastatin combined with indobufen(observation group),51 patients were treated with atorvastatin combined with aspirin(control group),and both groups were treated continuously for 6 months.The prethrombotic state indexes,neurological function and quality of daily life,carotid artery ultrasound indexes,renal fibrosis indexes before treatment and after treatment were compared between two group.The prethrombotic state indexes included arachidonic acid(AA)and adenosine diphosphate(ADP)induction platelet aggregation rate,fibrinogen(FIB),protein C;the National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological function,and the modified Barthel index(MBI)was used to evaluate the quality of daily life;carotid artery ultrasound indexes included carotid artery intima-media thickness(IMT)and maximum plaque area;the renal fibrosis indexes included transforming growth factor-β1(TGF-β1),matrix metalloproteinase-9(MMP-9),hyaluronic acid and platelet derived growth factor-BB(PDGF-BB).The adverse reactions were recorded.Results There were no statistical differences in the all indexes before treatment between two groups(P>0.05).In two groups,compared before treatment,the AA induction platelet aggregation rate,ADP induction platelet aggregation rate,FIB,NIHSS score,IMT and maximum plaque area after treatment were significantly lower,the protein C and MBI score were significantly higher,and there were statistical differences(P<0.01);but there were no statistical differences after treatment between two groups(P>0.05).The TGF-β1,MMP-9,hyaluronic acid and PDGF-BB after treatment in two groups were significantly lower than before treatment,and the indexes in observation group were significantly lower than those in control group:(39.46±6.89)μg/L vs.(45.04±8.20)μg/L,(278.46±49.39)μg/L vs.(327.30±57.28)μg/L,(102.37±20.62)μg/L vs.(116.84±24.97)μg/L vs.(25.26±4.45)μg/L vs.(28.13±5.08)μg/L,with statistically significant differences(P<0.01).The incidence of adverse reactions in observation group was significantly lower than that in control group:7.84%(4/51)vs.23.53%(12/51),and there was statistical difference(P<0.05).Conclusions Compared with atorvastatin combined with aspirin,atorvastatin combined with indobufen in elderly patients with DKD complicated with LAA-IS during convalescence has the same effect in improving the related indicators of prethrombotic state,reducing neurological function deficit,improving the ability of daily living,and reversing carotid atherosclerosis.However,atorvastatin combined with indobufen can further protect renal function with higher safety.
作者
李美杰
马艳
时伟
张立娜
白康
郭书琴
Li Meijie;Ma Yan;Shi Wei;Zhang Lina;Bai Kang;Guo Shuqin(Department of Neurology 3-Geriatric,Baoding Second Central Hospital,Zhuozhou 072750,China)
出处
《中国医师进修杂志》
2024年第3期247-253,共7页
Chinese Journal of Postgraduates of Medicine
关键词
糖尿病肾病
糖尿病
2型
老年人
脑梗死
阿托伐他汀
吲哚布芬
Diabetic nephropathies
Diabetes mellitus,type 2
Aged
Brain infarction
Atorvastatin
Indobufen
