厄贝沙坦联合阿托伐他汀钙对早期糖尿病肾病患者血清ox-LDL、hcy水平的影响
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摘要
目的探讨厄贝沙坦联合阿托伐他汀钙对早期糖尿病肾病(DN)患者血糖、血脂、肾功能损伤及血清氧化低密度脂蛋白(ox-LDL)和高同型半胱氨酸(hcy)的影响。方法将160例在该院进行治疗的DN患者纳入研究,采用随机数字表法将患者分为A、B、C、D组,每组40例。A组采用常规治疗,B组采用厄贝沙坦治疗,C组采用阿托伐他汀钙治疗,D组采用联合治疗。比较4组患者血糖、血脂、肾功能和血清ox-LDL、hcy水平的差异。结果 4组患者治疗2个月后血糖、血脂和肾功能各项参数指标及血清ox-LDL和hcy水平均较治疗前有所改善,且D组患者血糖、血脂各项参数指标及尿素氮(BUN)、尿微量清蛋白/肌酐(UALB/Cr)、血清ox-LDL和hcy水平均明显低于其他三组,而肾小球滤过率估计值(eGFR)水平明显高于其他三组,差异均有统计学意义(P<0.05)。ox-LDL、hcy水平降低是厄贝沙坦联合阿托伐他汀钙治疗早期糖尿病患者临床疗效良好的影响因素。结论厄贝沙坦联合阿托伐他汀钙可有效改善早期DN患者血糖、血脂代谢和肾功能损伤,降低血清ox-LDL、hcy水平,值得临床推广应用。
Objective To investigate the clinical effect of irbesartan combined with atorvastatin calcium on the levels of serum glucose,lipid,renal function,oxidized low-density lipoprotein(ox-LDL)and hemocysteine(hcy)in the early treatment of diabetic nephropathy(DN).Methods A total of 160 DN patients with typeⅡdiabetes in the hospital were enrolled and divided into group A,group B,group C and group D at random,40 cases in each group.The patients in the group A adopted traditional treatment,the group B with irbesartan,the group C with atorvastatin calcium,and the group D with irbesartan combined with atorvastatin calcium.The levels of serum glucose,lipid,renal function and ox-LDL,hcy levels were detected and compared among the four groups.Results After 2-month treatment,the levels of serum glucose,lipid,renal function,ox-LDL and hcy in the four groups were improved than those before treatment,and the levels of serum glucose,lipid BUN,UALB/Cr,ox-LDL and hcy in the group D were lower than those in the other three groups,while the value of eGFR was higher than that in the other three groups,the difference had statistically significant difference(P<0.05).The reduction of the levels of serum ox-LDL and hcy was independent factors of the clinical effect of irbesartan combined with atorvastatin calcium on early DN patients.Conclusion The application of irbesartan combined with atorvastatin calcium in early treatment of diabetic nephropathy could effectively improve the renal function and decrase the serum levels of ox-LDL and hcy,and the application is worthy of clinical promotion.
Objective To investigate the clinical effect of irbesartan combined with atorvastatin calcium on the levels of serum glucose,lipid,renal function,oxidized low-density lipoprotein(ox-LDL)and hemocysteine(hcy)in the early treatment of diabetic nephropathy(DN).Methods A total of 160 DN patients with typeⅡdiabetes in the hospital were enrolled and divided into group A,group B,group C and group D at random,40 cases in each group.The patients in the group A adopted traditional treatment,the group B with irbesartan,the group C with atorvastatin calcium,and the group D with irbesartan combined with atorvastatin calcium.The levels of serum glucose,lipid,renal function and ox-LDL,hcy levels were detected and compared among the four groups.Results After 2-month treatment,the levels of serum glucose,lipid,renal function,ox-LDL and hcy in the four groups were improved than those before treatment,and the levels of serum glucose,lipid BUN,UALB/Cr,ox-LDL and hcy in the group D were lower than those in the other three groups,while the value of eGFR was higher than that in the other three groups,the difference had statistically significant difference(P<0.05).The reduction of the levels of serum ox-LDL and hcy was independent factors of the clinical effect of irbesartan combined with atorvastatin calcium on early DN patients.Conclusion The application of irbesartan combined with atorvastatin calcium in early treatment of diabetic nephropathy could effectively improve the renal function and decrase the serum levels of ox-LDL and hcy,and the application is worthy of clinical promotion.
引文
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[10] WANG H,CUI K,XU K,er al.Association between plasma homocysteine and progression of early nephropathy in type 2diabetic patients[J].Int J Clin Exp Med,2015,8(7):11174-11180.
[11]许红兰,万美燕,夏平,等.ox-LDL检测在糖尿病肾病患者中的价值[J].实用临床医药杂志,2015,19(3):47-49.
[12]KAHRAMAN C,KAHRAMAN N K,ARAS B,et al.The relationship between neutrophil-to-lymphocyte ratio and albuminuria in type 2diabetic patients:apilot study[J].Arch Med Sci,2016,12(3):571-575.
[13] HERNYAVSKIY I,VEERANKI S,SEN U,et al.Atherogenesis:hyperhomocysteinemia interactions with LDL,macrophage function,paraoxonase 1,and exercise[J].Ann N Y Acad Sci,2016,1363:138-154.
[14]JOHNSON S A,SPURNEY R F.Twenty years after ACEIs and ARBs:emerging treatment strategies for diabetic nephropathy[J].Am J Physiol Renal Physiol,2015,309(10):F807-820.
[15]MOSE F H,LARSEN T,JENSEN J M,et al.Effects of atorvastatin on systemic and renal NO dependency in patients with non-diabeticstageⅡ-Ⅲchronic kidney disease[J].Br J Clin Pharmacol,2014,78(4):789-799.
[2] LINDBLOM R,HIGGINS G,COUGHLAN M,et al.Targeting mitochondria and reactive oxygen species-driven pathogenesis in diabetic nephropathy[J].Rev Diabet Stud,2015,12(1/):134-156.
[3] DOUNOUSI E,DUNI A,LEIVADITIS K,et al.Improvements in the management of diabetic nephropathy[J].Rev Diabet Stud,2015,12(1/2):119-133.
[4] ZHU M,DU J,CHEN S,et al.L-cystathionine inhibits the mitochondria-mediated macrophage apoptosis induced by oxidizedlow density lipoprotein[J].Int J Mol Sci,2014,15(12):23059-23073.
[5]李生兵,汤世国.贝前列素钠联合厄贝沙坦治疗糖尿病肾病的疗效观察[J].检验医学与临床,2012,9(15):1840-1841.
[6]中华医学会糖尿病学分会微血管并发症学组.糖尿病肾病防治专家共识(2014年版)[J].中华糖尿病杂志,2014,6(11):792-801.
[7]崔吉勇.阿托伐他汀对糖尿病肾病患者肾脏功能保护作用探讨[J].世界最新医学信息文摘,2016,16(71):17-18.
[8] TRAMONTI G,KANWAR Y S.Review and discussion of tubular biomarkers in the diagnosis and management of diabeticnephropathy[J].Endocrine,2013,43(3):494-503.
[9] KLEIN R,MYERS C E,LEE K E,et al.Oxidized lowdensity lipoprotein and the incidence of proliferative diabetic retinopathy and clinically significant macular edema determined from fundus photographs[J].JAMA Ophthalmol,2015,133(9):1054-1061.
[10] WANG H,CUI K,XU K,er al.Association between plasma homocysteine and progression of early nephropathy in type 2diabetic patients[J].Int J Clin Exp Med,2015,8(7):11174-11180.
[11]许红兰,万美燕,夏平,等.ox-LDL检测在糖尿病肾病患者中的价值[J].实用临床医药杂志,2015,19(3):47-49.
[12]KAHRAMAN C,KAHRAMAN N K,ARAS B,et al.The relationship between neutrophil-to-lymphocyte ratio and albuminuria in type 2diabetic patients:apilot study[J].Arch Med Sci,2016,12(3):571-575.
[13] HERNYAVSKIY I,VEERANKI S,SEN U,et al.Atherogenesis:hyperhomocysteinemia interactions with LDL,macrophage function,paraoxonase 1,and exercise[J].Ann N Y Acad Sci,2016,1363:138-154.
[14]JOHNSON S A,SPURNEY R F.Twenty years after ACEIs and ARBs:emerging treatment strategies for diabetic nephropathy[J].Am J Physiol Renal Physiol,2015,309(10):F807-820.
[15]MOSE F H,LARSEN T,JENSEN J M,et al.Effects of atorvastatin on systemic and renal NO dependency in patients with non-diabeticstageⅡ-Ⅲchronic kidney disease[J].Br J Clin Pharmacol,2014,78(4):789-799.