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目的观察舒洛地特联合氯沙坦对早期糖尿病肾病(DN)的疗效。方法将65例DN患者随机分为3组;舒洛地特组给予常规降糖治疗的同时肌注舒洛地特600LSU,1次/d,治疗4周后改为口服250LSU,2次/d,疗程4周;氯沙坦钾组在常规降糖治疗的同时每日晨口服氯沙坦钾50mg治疗8周;联合治疗组在常规降糖治疗的基础上,同时给予舒洛地特(600LSU,肌注,1次/d,4周后改为口服250LSU,2次/d,疗程4周)和氯沙坦钾(50mg,口服,1次/d,疗程8周)。比较治疗前后各组尿白蛋白排泄率(UAER)、肌酐(SCr)、尿素氮(BUN)以及血浆纤溶酶原激活剂抑制物-1(PAI-1)的变化。结果治疗后三组UAER均有下降:舒洛地特组UAER下降28.53%,氯沙坦钾组下降26.67%,联合治疗组UAER下降43.72%。其中,舒洛地特组与氯沙坦钾组比较差异无统计学意义(P>0.05);两组与联合治疗组比较差异有统计学意义(P<0.05)。并且3组PAI-1在治疗后有一定程度下降,与治疗前比较差异有统计学意义(P<0.05);而SCr与BUN在治疗前后差异无统计学意义(P>0.05)。结论舒洛地特联合氯沙坦钾能够减少早期糖尿病肾病患者的尿白蛋白排泄率,效果优于单一用药,能更好的延缓糖尿病肾病的进展。
Objective To observe the effect of sulodexide and losartan on early diabetic nephropathy (DN). Methods Sixty-five patients with DN were randomly divided into three groups. Patients in the sulodexide group were treated with conventional hypoglycemic therapy and received 600 LSU of sulfordil once a day for 4 weeks. After 2 weeks of treatment, they were switched to oral 250LSU twice daily , Treatment for 4 weeks; Losartan potassium group daily oral Losartan potassium 50mg for 8 weeks in the routine hypoglycemic treatment; combination therapy group on the basis of conventional hypoglycemic therapy, while giving sulodexide (600LSU , Intramuscular injection, once / d, 4 weeks later changed to oral 250LSU, 2 times / d, treatment for 4 weeks) and losartan potassium (50mg, orally, 1 time / d, 8 weeks). The changes of urinary albumin excretion rate (UAER), creatinine (SCr), blood urea nitrogen (BUN) and plasma plasminogen activator inhibitor-1 (PAI-1) were compared before and after treatment. Results After treatment, the UAER decreased in all three groups: the UAER decreased by 28.53% in the sulodentia group, decreased by 26.67% in the losartan potassium group and decreased by 43.72% in the combined treatment group. Among them, there was no significant difference between losartan and losartan potassium groups (P> 0.05). The difference between the two groups was statistically significant (P <0.05). The PAI-1 levels in three groups decreased to a certain extent after treatment, with statistical significance (P <0.05). However, there was no significant difference between before and after treatment of SCr and BUN (P> 0.05). Conclusions Both sulodexide and losartan potassium can reduce urinary albumin excretion rate in patients with early stage diabetic nephropathy, which is better than single medication and can delay the progress of diabetic nephropathy.