摘要
目的探讨前列地尔联合左卡尼汀对终末期糖尿病肾病(ESDN)患者肾功能、血清Toll样受体-4(TLR-4)、白介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)水平的影响。方法将2015年1月至2018年1月间收治的88例ESDN患者采用随机数表法分为观察组(n=44)和对照组(n=44)。2组均应用前列地尔,观察组在此基础上联合左卡尼汀。评估治疗前、治疗4周后2组患者肾功能[血肌酐(SCr)、尿素氮(BUN)、肾小球滤过率(eGFR)]、炎性因子(TLR-4、IL-18、TNF-α)、血生化指标[血红蛋白(Hb)、血白蛋白(ALB)、胆固醇(TC)],记录2组透析不良反应发生率。结果 (1)治疗4周后,2组SCr、BUN水平均低于治疗前(P<0.05),观察组降幅大于对照组(P<0.05);2组治疗前后及组间eGFR对比,差异均无统计学意义(P>0.05);(2)治疗4周后,2组TLR-4、IL-18、TNF-α指标水平均低于治疗前(P<0.05),观察组降幅大于对照组(P<0.05);(3)治疗4周后,2组Hb、ALB指标水平均高于治疗前(P<0.05),2组TC指标水平均低于治疗前(P<0.05),观察组变动幅度均大于对照组(P<0.05);(4)观察组不良反应发生率低于对照组(P<0.05)。结论前列地尔联合左卡尼汀有利于降低炎性因子水平,保护患者肾功能,并能降低其不良反应发生风险。
Objective To explore the effects of alprostadil combined with levocarnitine on renal function and serum levels of toll-like receptor-4(TLR-4),interleukin-18(IL-18)and tumor necrosis factor-α(TNF-α)in patients with end-stage diabetic nephropathy(ESDN). Methods 88 cases of patients with ESDN admitted between January 2015 and January 2018 were divided into observation group(n=44)and control group(n=44)according to the random number table method. Alprostadil was applied to both groups,and the observation group was combined with levocarnitine. Renal function[serum creatinine(SCr),urea nitrogen(BUN),glomerular filtration rate(eGFR)],inflammatory factors(TLR-4,IL-18,TNF-α)and blood biochemical indicators[hemoglobin(Hb),serum albumin(ALB),cholesterol(TC)]were evaluated before treatment and after 4 weeks of treatment. And the incidence rate of dialysis adverse reactions was recorded in the 2 groups. Results After 4 weeks of treatment,the levels of SCr and BUN in the 2 groups were lower than those before treatment(P<0.05),and the decrease in observation group was greater than that in control group(P<0.05). There was no significant difference in the eGFR within-groups before and after treatment and between-groups(P>0.05). After 4 weeks of treatment,the levels of TLR-4,IL-18 and TNF-αin the 2 groups were lower than those before treatment(P<0.05),and the decrease in observation group was greater than that in control group(P<0.05). After 4 weeks of treatment,the levels of Hb and ALB in the 2 groups were higher than those before treatment(P<0.05)while the TC level in the 2 groups was lower than that before treatment(P<0.05),and the changes in observation group were greater than those in control group(P<0.05). The incidence rate of adverse reactions in observation group was lower than that in control group(P<0.05). Conclusions Alprostadil combined with levocarnitine is beneficial to reduce the levels of inflammatory factors,protect patients. renal function,and reduce the risk of adverse reactions.
引文
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