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目的观察二甲双胍联合地特胰岛素治疗2型糖尿病肾病的临床疗效。方法将2型糖尿病肾病患者150例随机分为2组,每组75例。对照组给予地特胰岛素治疗,治疗组给予二甲双胍联合地特胰岛素治疗,观察2组患者治疗前后血肌酐(SCr)、内生肌酐清除率(Ccr)、尿素氮(BUN)、尿蛋白及胰岛β细胞功能变化情况,比较2组总有效率。结果 (1)治疗组Ccr≥15ml/min患者总有效率高于对照组Ccr≥15ml/min患者(P<0.01),2组Ccr<15ml/min患者总有效率比较差异无统计学意义(P>0.05)。(2)治疗组治疗后肾功能、24h尿蛋白、尿禁水渗透压、尿β2-微球蛋白(β2-MG)、尿α1-微球蛋白(α1-MG)均显著改善(P<0.01),且与对照组比较差异均有统计学意义(P<0.05或P<0.01);对照组治疗后血BUN、24h尿蛋白下降(P<0.05),血红蛋白(Hb)、尿禁水渗透压升高(P<0.05),治疗后SCr、Ccr、β2-MG及α1-MG虽有改善,但与治疗前比较差异无统计学意义(P>0.05)。(3)治疗后2组患者胰岛素分泌指数(HOMA-B)、胰岛素抵抗指数(HOMA-IR)、1h INS/FINS均显著改善(P<0.05),且治疗组优于对照组(P<0.05);2组治疗后空腹胰岛素(FINS)水平均下降(P<0.05),但2组间比较差异无统计学意义(P>0.05);治疗前后及组间胰岛素敏感指数(ISI)比较差异均无统计学意义(P>0.05)。结论二甲双胍联合地特胰岛素治疗2型糖尿病肾病疗效显著,能显著改善患者胰岛β功能和肾功能,缓解患者临床症状,值得临床推广应用。
Objective To observe the clinical efficacy of metformin combined with insulin detemir in the treatment of type 2 diabetic nephropathy. Methods 150 patients with type 2 diabetic nephropathy were randomly divided into two groups, 75 cases in each group. The control group was given insulin detemir treatment. The treatment group was treated with metformin and insulin detemir. The levels of serum creatinine (SCr), creatinine clearance (Ccr), blood urea nitrogen (BUN), urine protein and islet β Changes in cell function, the total effective rate of 2 groups. Results (1) The total effective rate of patients with Ccr≥15ml / min was higher than that of patients with Ccr≥15ml / min (P <0.01). There was no significant difference in total effective rate between two groups (P > 0.05). (2) After treatment, the renal function, urinary protein excretion, water forcings, urinary β2-microglobulin (α2-microglobulin) and urinary α1-microglobulin (P <0.05 or P <0.01). In the control group, the levels of BUN and 24 h proteinuria decreased (P <0.05), and hemoglobin (Hb) (P <0.05). After treatment, SCr, Ccr, β2-MG and α1-MG improved, but there was no significant difference compared with before treatment (P> 0.05). (3) After treatment, HOMA-B, HOMA-IR and INS / FINS of 1h were significantly improved (P <0.05), and the treatment group was better than the control group (P <0.05) ). After treatment, the levels of fasting insulin (FINS) decreased (P <0.05), but there was no significant difference between the two groups (P> 0.05). The difference of insulin sensitivity index (ISI) No statistical significance (P> 0.05). Conclusion Metformin combined with insulin detemir treatment of type 2 diabetic nephropathy significant effect, can significantly improve the patient’s beta function and renal function, alleviate the clinical symptoms, deserved clinical application.