前列地尔联合左卡尼汀对ESDN患者肾功能、炎性因子的影响
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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.
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
[1]陈国光.腹膜透析治疗终末期糖尿病肾病的综合评价[J].中国药物与临床,2016,16(7):1022-1023.
[2]毕艳.中国糖尿病慢性并发症的流行病学研究现况[J].中华糖尿病杂志,2015,7(8):467-469.
[3]袁江红,王文兵.ESDN腹膜透析与血液透析患者临床分析及预后比较[J].中国中西医结合肾病杂志,2016,17(9):821-823.
[4]黄乙芸,王欣,张月莉,等.糖尿病肾病微炎症与营养不良的研究进展[J].现代中西医结合杂志,2018,27(11):1247-1249.
[5]江波,王晓斐,江华,等.左卡尼汀辅助不同血液透析方式在终末期糖尿病肾病中的应用价值[J].解放军医药杂志,2016,28(b10):47-49.
[6]王天生,王盛琴,王东红,等.终末期肾病维持血液透析患者应用左卡尼汀治疗对T淋巴细胞亚群和可溶性白细胞介素2受体的影响[J].中国慢性病预防与控制,2016,24(2):144-146.
[7]刘新荪.左卡尼汀对慢性肾衰竭非透析患者蛋白质能量消耗的影响[J].中国中西医结合肾病杂志,2016,17(4):340-341.
[8]赵建明,朱小华,牟爱华.血液灌流联合血液透析与左卡尼汀对慢性肾衰竭患者贫血和钙磷代谢及炎性因子的影响[J].中国临床研究,2018,31(7):914-917.
[9]童国玉,朱大龙.糖尿病肾病国内外临床指南和专家共识解读[J].中国实用内科杂志,2017,37(3):211-216.
[10]张倩,田风胜.糖尿病肾病凝血功能变化与心脑血管疾病关系的研究进展[J].微循环学杂志,2016,26(1):69-71.
[11]石冰青,孙广东.前列地尔在糖尿病肾病中的研究进展[J].临床与病理杂志,2017,37(12):2709-2716.
[12]苏真,陈建梅.左卡尼汀对糖尿病肾病透析病人炎性因子与红细胞免疫的影响[J].蚌埠医学院学报,2017,42(10):1349-1352.
[13]王晓茹,周秀岚,马惠红.左卡尼汀联合前列地尔治疗糖尿病肾病的临床疗效及其安全性[J].药物评价研究,2017,40(10):1481-1484.
[14]王思静.终末期糖尿病肾病的肾脏替代治疗研究进展[J].国际泌尿系统杂志,2017,37(4):623-626.
[15]冯云生,赵亚娟,张宝红,等.血液透析联合血液灌流对终末期糖尿病肾病患者血清炎症因子水平及营养不良的影响[J].河北医学,2016,22(7):1114-1116.
[16]陈松锦.外周血单核细胞Toll样受体2及Toll样受体4表达与糖尿病肾病的相关性[J].检验医学与临床,2017,14(12):1747-1748.
[17]权泽威,孔天宇,哈利,等.前列地尔对老年糖尿病肾病病人氧化应激、炎性因子及血管内皮因子的影响[J].实用老年医学,2018,32(6):572-576.
[18]杨芦蓉,杨林,宋志霞,等.左卡尼汀对糖尿病腹膜透析患者外周血T细胞亚群及炎症因子的影响[J].中国药房,2017,28(20):2837-2840.
[19]余伍中,高国胜.左卡尼汀对维持性血液透析患者营养指标及炎症状态的影响[J].华西医学,2016,31(1):25-28.
[20]史军海,周麟.腹膜透析治疗终末期糖尿病肾病的临床疗效[J].江苏医药,2018,44(5):501-504.
[21]金刚,董倩兰,梁衍,等.左卡尼汀联合血液透析对终末期肾病患者临床疗效及安全性评价[J].西部医学,2018,30(2):197-200,204.
[22]胡跃玲,陈明.左卡尼汀在心血管疾病中的研究进展[J].心血管病学进展,2018,39(3):426-429.
[23]夏朝霞,路伟,汪代杰,等.左卡尼汀联合前列地尔治疗糖尿病肾病的临床研究[J].中国临床药理学杂志,2016,32(13):1172-1174.
[24]黄娟,胡维,熊丹.左卡尼汀联合前列地尔治疗糖尿病肾病的疗效及其对患者血清Cys C及RBP水平的影响[J].海南医学,2018,29(2):183-186.
[2]毕艳.中国糖尿病慢性并发症的流行病学研究现况[J].中华糖尿病杂志,2015,7(8):467-469.
[3]袁江红,王文兵.ESDN腹膜透析与血液透析患者临床分析及预后比较[J].中国中西医结合肾病杂志,2016,17(9):821-823.
[4]黄乙芸,王欣,张月莉,等.糖尿病肾病微炎症与营养不良的研究进展[J].现代中西医结合杂志,2018,27(11):1247-1249.
[5]江波,王晓斐,江华,等.左卡尼汀辅助不同血液透析方式在终末期糖尿病肾病中的应用价值[J].解放军医药杂志,2016,28(b10):47-49.
[6]王天生,王盛琴,王东红,等.终末期肾病维持血液透析患者应用左卡尼汀治疗对T淋巴细胞亚群和可溶性白细胞介素2受体的影响[J].中国慢性病预防与控制,2016,24(2):144-146.
[7]刘新荪.左卡尼汀对慢性肾衰竭非透析患者蛋白质能量消耗的影响[J].中国中西医结合肾病杂志,2016,17(4):340-341.
[8]赵建明,朱小华,牟爱华.血液灌流联合血液透析与左卡尼汀对慢性肾衰竭患者贫血和钙磷代谢及炎性因子的影响[J].中国临床研究,2018,31(7):914-917.
[9]童国玉,朱大龙.糖尿病肾病国内外临床指南和专家共识解读[J].中国实用内科杂志,2017,37(3):211-216.
[10]张倩,田风胜.糖尿病肾病凝血功能变化与心脑血管疾病关系的研究进展[J].微循环学杂志,2016,26(1):69-71.
[11]石冰青,孙广东.前列地尔在糖尿病肾病中的研究进展[J].临床与病理杂志,2017,37(12):2709-2716.
[12]苏真,陈建梅.左卡尼汀对糖尿病肾病透析病人炎性因子与红细胞免疫的影响[J].蚌埠医学院学报,2017,42(10):1349-1352.
[13]王晓茹,周秀岚,马惠红.左卡尼汀联合前列地尔治疗糖尿病肾病的临床疗效及其安全性[J].药物评价研究,2017,40(10):1481-1484.
[14]王思静.终末期糖尿病肾病的肾脏替代治疗研究进展[J].国际泌尿系统杂志,2017,37(4):623-626.
[15]冯云生,赵亚娟,张宝红,等.血液透析联合血液灌流对终末期糖尿病肾病患者血清炎症因子水平及营养不良的影响[J].河北医学,2016,22(7):1114-1116.
[16]陈松锦.外周血单核细胞Toll样受体2及Toll样受体4表达与糖尿病肾病的相关性[J].检验医学与临床,2017,14(12):1747-1748.
[17]权泽威,孔天宇,哈利,等.前列地尔对老年糖尿病肾病病人氧化应激、炎性因子及血管内皮因子的影响[J].实用老年医学,2018,32(6):572-576.
[18]杨芦蓉,杨林,宋志霞,等.左卡尼汀对糖尿病腹膜透析患者外周血T细胞亚群及炎症因子的影响[J].中国药房,2017,28(20):2837-2840.
[19]余伍中,高国胜.左卡尼汀对维持性血液透析患者营养指标及炎症状态的影响[J].华西医学,2016,31(1):25-28.
[20]史军海,周麟.腹膜透析治疗终末期糖尿病肾病的临床疗效[J].江苏医药,2018,44(5):501-504.
[21]金刚,董倩兰,梁衍,等.左卡尼汀联合血液透析对终末期肾病患者临床疗效及安全性评价[J].西部医学,2018,30(2):197-200,204.
[22]胡跃玲,陈明.左卡尼汀在心血管疾病中的研究进展[J].心血管病学进展,2018,39(3):426-429.
[23]夏朝霞,路伟,汪代杰,等.左卡尼汀联合前列地尔治疗糖尿病肾病的临床研究[J].中国临床药理学杂志,2016,32(13):1172-1174.
[24]黄娟,胡维,熊丹.左卡尼汀联合前列地尔治疗糖尿病肾病的疗效及其对患者血清Cys C及RBP水平的影响[J].海南医学,2018,29(2):183-186.