百令片联合雷公藤多甙片治疗IV期糖尿病肾病临床效果观察(1)
[摘要] 目的 观察百令片联合雷公藤多甙治疗IV期糖尿病肾病(diabetic kidney disease，DKD)的临床疗效。方法 收集2015年8—12月期间在该院肾脏内科确诊为IV期DKD的患者共27例，给予百令片(5片/次，3次/d联合雷公藤多甙片[1 mg/(kg·d)，分3次口服]连续服用6个月。分别在用药前、用药后3个月和6个月时测定患者24 h尿总蛋白定量(24 h-UTP)、尿N-乙酰-β-氨基葡萄糖苷酶(尿NAG酶)、血超敏C-反应蛋白(血hs-CRP)、尿微量白蛋白/肌酐(UACR)、血白蛋白(血ALB)，比较其差异，用来评价两药连用对IV期DKD的临床治疗效果并观察其不良反应。结果 治疗后患者24 h-UTP、尿NAG酶及血hs-CRP、UACR较治疗前相比，显著下降，且差异有统计学意义。27例患者血ALB显著升高，且治疗前后差异有统计学意义(P<0.05)。结论 百令片联合雷公藤多甙片治疗IV期DKA临床效果显著且安全，值得临床推广使用。
[关键词] 百令片；雷公藤多甙片；糖尿病肾病
[中图分类号] R259 [文献标识码] A [文章编号] 1672-4062(2017)03(b)-0076-03
[Abstract] Objective To observe the clinical effect of bailing tablets and tripterygium wilfordii glycoside tablets in treatment of diabetic nephropathy during the IV stage. Methods 27 cases of DKD patients during the IV stage in our hospital from August to December 2015 were selected and were given the bailing tablets ( 5 every time， three times daily) and tripterygium wilfordii glycoside tablets[1 mg/(kg·d)， oral three times] for consecutive six months， and the 24 h-UTP， urine NAG， serum hs-CRP， UACR， serum albumin were measured before medication， in 3 months and 6 months after medication， and the clinical treatment effect was evaluated and the adverse reactions were observed. Results After treatment， the 24 h-UTP， urine NAG， serum hs-CRP and UACR obviously decreased compared with those before treatment， and the differences were statistically significant， and of 27 cases， the serum ALB obviously increased and the difference before and after treatment was statistically significant(P<0.05). Conclusion The clinical effect of bailing tablets and tripterygium wilfordii glycoside tablets in treatment of diabetic nephropathy during the IV stage is obvious with safety， which is worth clinical promotion and application.
[Key words] Bailing tablets； Tripterygium wilfordii glycoside tablets； Diabetic nephropathy
DKD是糖尿病最常見的慢性微血管并发症之一，从初期微量蛋白尿到终末期肾功能衰竭，其临床进展共分为5期[1]。其病因及致病机制复杂，主要包括糖代谢异常、血流动力学改变、细胞因子及生长因子作用、遗传因素等方面。同时，涉及到肾素-血管紧张素-醛固酮系统(RAAS)的活化、糖基化终末产物的积聚、多元醇途径的激活、氧化应激异常等。不同分期糖尿病肾病的临床表现各不相同。临床IV期DKD以持续大量蛋白尿、水肿、高血压为主要特点，渐至肾功能衰竭。其病程长，治疗棘手，目前临床上尚没有能够较好的控制DKD的药物。该研究联合应用百令片及雷公藤多甙片治疗IV期DKD取得了不错的临床效果，且不良反应较少，现报道如下。
1 资料与方法
1.1 一般资料
收集2015年8—12月在武汉大学人民医院肾脏内科以糖尿病合并IV期DKD患者27例，男性15例，女性12例，年龄在32～55岁。平均年龄为43.3岁。有3例患者因临床表现符合糖尿病肾病表现，但糖尿病病程<5年，表现为肾病综合征，但无糖尿病视网膜病变及神经病变。遂经肾活检确诊为IV期DKD。其余患者纳入及排除标准如下：①治疗前尿蛋白定量均>1 g/24 h。②除糖尿病外，均无其他心、脑、肝、肺等严重器质性病变。③无精神心理异常及认知功能障碍。④诊断标准参照第八版内科学中IV期DKD的诊断标准。⑤不合并其他糖尿病合并症，如糖尿病酮症酸中毒、高糖高渗血症、糖尿病足、严重感染等。⑥排除对研究药物有过敏现象患者。该研究为前后对照研究，经该院伦理委员会审核通过，所有患者均签署知情同意。, 百拇医药(王心 陈铖 严苗)
[关键词] 百令片；雷公藤多甙片；糖尿病肾病
[中图分类号] R259 [文献标识码] A [文章编号] 1672-4062(2017)03(b)-0076-03
[Abstract] Objective To observe the clinical effect of bailing tablets and tripterygium wilfordii glycoside tablets in treatment of diabetic nephropathy during the IV stage. Methods 27 cases of DKD patients during the IV stage in our hospital from August to December 2015 were selected and were given the bailing tablets ( 5 every time， three times daily) and tripterygium wilfordii glycoside tablets[1 mg/(kg·d)， oral three times] for consecutive six months， and the 24 h-UTP， urine NAG， serum hs-CRP， UACR， serum albumin were measured before medication， in 3 months and 6 months after medication， and the clinical treatment effect was evaluated and the adverse reactions were observed. Results After treatment， the 24 h-UTP， urine NAG， serum hs-CRP and UACR obviously decreased compared with those before treatment， and the differences were statistically significant， and of 27 cases， the serum ALB obviously increased and the difference before and after treatment was statistically significant(P<0.05). Conclusion The clinical effect of bailing tablets and tripterygium wilfordii glycoside tablets in treatment of diabetic nephropathy during the IV stage is obvious with safety， which is worth clinical promotion and application.
[Key words] Bailing tablets； Tripterygium wilfordii glycoside tablets； Diabetic nephropathy
DKD是糖尿病最常見的慢性微血管并发症之一，从初期微量蛋白尿到终末期肾功能衰竭，其临床进展共分为5期[1]。其病因及致病机制复杂，主要包括糖代谢异常、血流动力学改变、细胞因子及生长因子作用、遗传因素等方面。同时，涉及到肾素-血管紧张素-醛固酮系统(RAAS)的活化、糖基化终末产物的积聚、多元醇途径的激活、氧化应激异常等。不同分期糖尿病肾病的临床表现各不相同。临床IV期DKD以持续大量蛋白尿、水肿、高血压为主要特点，渐至肾功能衰竭。其病程长，治疗棘手，目前临床上尚没有能够较好的控制DKD的药物。该研究联合应用百令片及雷公藤多甙片治疗IV期DKD取得了不错的临床效果，且不良反应较少，现报道如下。
1 资料与方法
1.1 一般资料
收集2015年8—12月在武汉大学人民医院肾脏内科以糖尿病合并IV期DKD患者27例，男性15例，女性12例，年龄在32～55岁。平均年龄为43.3岁。有3例患者因临床表现符合糖尿病肾病表现，但糖尿病病程<5年，表现为肾病综合征，但无糖尿病视网膜病变及神经病变。遂经肾活检确诊为IV期DKD。其余患者纳入及排除标准如下：①治疗前尿蛋白定量均>1 g/24 h。②除糖尿病外，均无其他心、脑、肝、肺等严重器质性病变。③无精神心理异常及认知功能障碍。④诊断标准参照第八版内科学中IV期DKD的诊断标准。⑤不合并其他糖尿病合并症，如糖尿病酮症酸中毒、高糖高渗血症、糖尿病足、严重感染等。⑥排除对研究药物有过敏现象患者。该研究为前后对照研究，经该院伦理委员会审核通过，所有患者均签署知情同意。, 百拇医药(王心 陈铖 严苗)