前列腺素E1联合ACEI治疗糖尿病肾病研究
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摘要
目的：观察前列腺素E1(PGE1)联合ACEI治疗不同时期糖尿病肾病随访1年的疗效。
方法：选取2005年7月至2007年7月期间,在山东省省立医院内分泌科住院的2型糖尿病患者中,符合条件的428例糖尿病肾病患者。根据Mogensen糖尿病肾病(DN)诊断标准分为Ⅲ、Ⅳ、Ⅴ期,其中Ⅳ期患者根据尿蛋白水平分为Ⅳ早期(尿蛋白<1.5 g／d)、Ⅳ中期(1.5 g／d<尿蛋白<2.5 g／d)和Ⅳ晚期(尿蛋白>2.5 g／d)。各期患者再随机分为四组,给予四种治疗方案：PGE1组、PGE1+血管紧张素转换酶抑制剂(ACEI)组、ACEI组和空白对照组。测定各组治疗前及治疗后15天、1年的24h尿蛋白和24h尿微量白蛋白水平。
结果：(1)Ⅲ期及Ⅳ早期患者：PGE1+ACEI组和PGE1组治疗后15天及1年时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),PGE1+ACEI组下降幅度始终大于ACEI组(P<0.01或P<0.05)。(2)Ⅳ中期及Ⅳ晚期患者：PGE1+ACEI组治疗后15天及1年时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),下降幅度始终大于ACEI组(P＜0.01). PGE1组治疗后15天时,两指标水平较治疗前明显下降(P<0.01),但治疗后1年时两指标下降幅度减小且水平高于ACEI组(P<0.05)。(3)V期患者：PGE1+ACEI组和PGE1组治疗后15天时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),下降幅度大于ACEI组(P<0.01)。治疗后1年时,PGE1+ACEI组的两指标水平与治疗前无统计学差异,但仍低于ACEI组：PGE1组及ACEI组的两指标水平较治疗前升高(P<0.05),两组之间无统计学差异。
结论：PGE1与ACEI联合应用治疗糖尿病肾病疗效肯定,能显著减少糖尿病肾病Ⅲ-Ⅴ期患者尿蛋白和尿微量白蛋白的量,随访1年时疗效仍好于单用前列腺素E1及ACEI,提示随时间延长疗效持续。对于糖尿病肾病V期疗效较Ⅲ-Ⅳ期为差,提示随着肾损害加重两者联合治疗仍有效,但疗效下降。
Objectives:To investigate the thrapeutic effects of combination therapy with prostaglandin E1 (PGE1) and angiotensin-converting enzyme inhibitor on diabetic nephropathy(DN) after one year.
Methods Patients with DN stageⅢ, stageⅣand stageⅤwere divided according to Mogensen diabetic nephropathy diagnostic criteria. Patients with stageⅣnephropathy were subdivided into three groups according to their amounts of proteinuria excreted:early stageⅣ(the amount of protienuria excreted was less than 1.5g/d), middle stageⅣ(the amount of protienuria was between 1.5g/d and 2.5g/d) and late stageⅣ(the amount of protienuria reached above 2.5g/d). They were randomly received PGE1 (PGE1 group), PGE1 plus angiotensin-converting enzyme inhibitor (ACEI, PGE1+ACEI group), ACEI mono-therapy (ACEI group) and control (control group). Proteinuria and albuminuria were measured before and after treatment for 15 days and 1 year.
Results:(1) In the patients with DN stageⅢand early stageⅣ, and their proteinuria and albuminuria descended significantly in PGEl+ACEI and PGE1 group after 15 days and 1 year compared with that pre-treatment(P<0.01) and the amplitudes descended were larger than that of ACEI group(P<0.01 or P<0.05). (2) In the patients with middle stage and late stageⅣnephropathy, the proteinuria and albuminuria decreased significantly in PGEl+ACEI group afterl5 days and 1 year compared with that pre-treatment (P<0.01) and the decreasing amplitude were larger than that of ACEI group (P<0.01). These two indicators descended significantly in PGEl group afterl5 days compared with that pre-treatment (P<0.01) but were higher than that of ACEI group one year later (P<0.05). (3) In the patients with stage V nephropathy, the proteinuria and albuminuria descended significantly in PGE1+ACEI and PGEl group afterl5 days compared with that pre-treatment (P<0.01) and the decreasing amplitude were larger than that of ACEI group (P<0.01 or P<0.05). These two indicators in PGE1+ACEI group had no statistical difference compared with that pre-treatment but were lower than that of ACEI group (P< 0.05) one year later,while they were higher than that pre-treatment(P<0.05) in ACEI and PGEl group.
Conclusions:The therapeutic effects are much better in patients with stageⅢnephropathy in comparation with stageⅤ. The combination of PGE1 and ACEI will get the best therapeutic effects and is more effective than PGE1 or ACEI alone even when following up to 1 year.
方法：选取2005年7月至2007年7月期间,在山东省省立医院内分泌科住院的2型糖尿病患者中,符合条件的428例糖尿病肾病患者。根据Mogensen糖尿病肾病(DN)诊断标准分为Ⅲ、Ⅳ、Ⅴ期,其中Ⅳ期患者根据尿蛋白水平分为Ⅳ早期(尿蛋白<1.5 g／d)、Ⅳ中期(1.5 g／d<尿蛋白<2.5 g／d)和Ⅳ晚期(尿蛋白>2.5 g／d)。各期患者再随机分为四组,给予四种治疗方案：PGE1组、PGE1+血管紧张素转换酶抑制剂(ACEI)组、ACEI组和空白对照组。测定各组治疗前及治疗后15天、1年的24h尿蛋白和24h尿微量白蛋白水平。
结果：(1)Ⅲ期及Ⅳ早期患者：PGE1+ACEI组和PGE1组治疗后15天及1年时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),PGE1+ACEI组下降幅度始终大于ACEI组(P<0.01或P<0.05)。(2)Ⅳ中期及Ⅳ晚期患者：PGE1+ACEI组治疗后15天及1年时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),下降幅度始终大于ACEI组(P＜0.01). PGE1组治疗后15天时,两指标水平较治疗前明显下降(P<0.01),但治疗后1年时两指标下降幅度减小且水平高于ACEI组(P<0.05)。(3)V期患者：PGE1+ACEI组和PGE1组治疗后15天时尿蛋白及尿微量白蛋白均较治疗前明显下降(P<0.01),下降幅度大于ACEI组(P<0.01)。治疗后1年时,PGE1+ACEI组的两指标水平与治疗前无统计学差异,但仍低于ACEI组：PGE1组及ACEI组的两指标水平较治疗前升高(P<0.05),两组之间无统计学差异。
结论：PGE1与ACEI联合应用治疗糖尿病肾病疗效肯定,能显著减少糖尿病肾病Ⅲ-Ⅴ期患者尿蛋白和尿微量白蛋白的量,随访1年时疗效仍好于单用前列腺素E1及ACEI,提示随时间延长疗效持续。对于糖尿病肾病V期疗效较Ⅲ-Ⅳ期为差,提示随着肾损害加重两者联合治疗仍有效,但疗效下降。
Objectives:To investigate the thrapeutic effects of combination therapy with prostaglandin E1 (PGE1) and angiotensin-converting enzyme inhibitor on diabetic nephropathy(DN) after one year.
Methods Patients with DN stageⅢ, stageⅣand stageⅤwere divided according to Mogensen diabetic nephropathy diagnostic criteria. Patients with stageⅣnephropathy were subdivided into three groups according to their amounts of proteinuria excreted:early stageⅣ(the amount of protienuria excreted was less than 1.5g/d), middle stageⅣ(the amount of protienuria was between 1.5g/d and 2.5g/d) and late stageⅣ(the amount of protienuria reached above 2.5g/d). They were randomly received PGE1 (PGE1 group), PGE1 plus angiotensin-converting enzyme inhibitor (ACEI, PGE1+ACEI group), ACEI mono-therapy (ACEI group) and control (control group). Proteinuria and albuminuria were measured before and after treatment for 15 days and 1 year.
Results:(1) In the patients with DN stageⅢand early stageⅣ, and their proteinuria and albuminuria descended significantly in PGEl+ACEI and PGE1 group after 15 days and 1 year compared with that pre-treatment(P<0.01) and the amplitudes descended were larger than that of ACEI group(P<0.01 or P<0.05). (2) In the patients with middle stage and late stageⅣnephropathy, the proteinuria and albuminuria decreased significantly in PGEl+ACEI group afterl5 days and 1 year compared with that pre-treatment (P<0.01) and the decreasing amplitude were larger than that of ACEI group (P<0.01). These two indicators descended significantly in PGEl group afterl5 days compared with that pre-treatment (P<0.01) but were higher than that of ACEI group one year later (P<0.05). (3) In the patients with stage V nephropathy, the proteinuria and albuminuria descended significantly in PGE1+ACEI and PGEl group afterl5 days compared with that pre-treatment (P<0.01) and the decreasing amplitude were larger than that of ACEI group (P<0.01 or P<0.05). These two indicators in PGE1+ACEI group had no statistical difference compared with that pre-treatment but were lower than that of ACEI group (P< 0.05) one year later,while they were higher than that pre-treatment(P<0.05) in ACEI and PGEl group.
Conclusions:The therapeutic effects are much better in patients with stageⅢnephropathy in comparation with stageⅤ. The combination of PGE1 and ACEI will get the best therapeutic effects and is more effective than PGE1 or ACEI alone even when following up to 1 year.
引文
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