缬沙坦联合吡格列酮治疗早期糖尿病肾病的疗效观察

目的:观察缬沙坦联合吡格列酮治疗早期糖尿病肾病的疗效及其对肾功能和氧化应激水平的影响。方法:选取2010年1月~2012年6月在我院就诊的早期糖尿病肾病患者90例,随机分为观察组和对照组,每组各45例。对照组予以吡格列酮治疗,观察组在对照组的基础上予以缬沙坦治疗。观察两组治疗前后的尿白蛋白排泄率(UAER)、β2微球蛋白(β2-MG)、血肌酐(SCr)、还原型谷胱甘肽(GSH)、丙二醛(MDA)和超氧化物歧化酶(SOD)活性水平的变化。结果:观察组和对照组的治疗总有效率分别为93.33%、75.56%,观察组显著高于对照组,差异有统计学意义(X2=4.145,P=0.042)。治疗后,两组患者的UAER、β2-MG、SCr和MDA水平均较治疗前明显降低(P0.01),且观察组以上指标的水平显著低于对照组(P0.01);而两组SOD和GSH水平均较治疗前明显升高(P0.01),且观察组以上指标的水平显著高于对照组,差异有统计学意义(P0.01)。结论:缬沙坦联合吡格列酮治疗早期糖尿病肾病的疗效较单用吡格列酮更好,并可显著改善患者的肾功能和降低氧化应激水平。

Efficacy of Valsartan Combined with Pioglitazone in the Patients with Early Diabetic Nephropathy

Objective： To observe the efficacy of valsartan combined with pioglitazone in the treatment of patients with early diabetic nephropathy and its impact on the renal function and oxidative stress. Methods： 90 patients with early diabetic nephropathy, from January 2010 to June 2012, were randomly divided into the observation group and control group, 45 cases in each group. The control group was treated by pioglitazone alone, while the observation group was given valsartan on the basis of control group. The urinary albumin excretion rate （UAER）, β2-microglobulin （β2-MG）, serum creatinine （SCr）, reduced ghitathione （GSH）, malondialdehyde （MDA） and super oxide dismutase （SOD） were observed before and after treatment. Results： The total effective rate of observation group and control group were respectively 93.33%, 75.56%, which was significantly higher in the observation group （X^2=-4.145, P=0.042）. After treatment, the levels of UAER, β2-MG, SCr and MDA in both groups were significantly lower than those before treatment（P〈0.01）, which were significantly lower in the observation group than those of the control group （P〈0.01）. However, the levels of SOD and GSH significantly increased in both groups compared with those before treatment （P〈0.01）, which were significantly higher in the observation group than those of the control group （P〈0.01）. Conclusion： The treatment of valsartan combined with pioglitazone was more effective to the patients with early diabetic nephropathy than pioglitazone alone, which significantly improved the kidney function and relieved the oxidative stress.