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目的探讨阿托伐他汀联合替米沙坦治疗急性冠脉综合征介入治疗后并发糖尿病肾病的临床疗效。方法选取湖南旺旺医院2014年5月—2016年5月收治的急性冠脉综合征合并糖尿病肾病患者80例,根据治疗方法不同分为对照组与观察组,各40例。两组患者均接受经皮冠状动脉介入治疗术(PCI)及充分水化治疗,对照组患者予以阿托伐他汀治疗,观察组患者在对照组基础上加用替米沙坦治疗,两组患者均连续治疗2周。比较两组患者介入治疗前、治疗2周后患者急性肾损伤情况、血脂指标[三酰甘油(TG)、总胆固醇(TC)]、肾功能指标[血肌酐(Scr)、尿蛋白定量(UAE)、尿素氮(BUN)、血浆胱抑素C(Cys C)及术后随机尿微量清蛋白/肌酐(ACR)比值]、心功能指标[左心室舒张末期内径(LVIDd)、左心室收缩末期内径(LVIDs)、左心室短轴缩短率(FS)、左心室射血分数(LVEF)]及随访6个月的不良心血管事件发生情况。结果介入治疗前两组患者急性肾损伤分期比较,差异无统计学意义(P<0.05);治疗2周后观察组急性肾损伤分期优于对照组(P<0.05)。观察组患者血清TC、TG、Scr、BUN、UAE、Cys C水平及随机尿ACR低于对照组(P<0.05)。观察组患者LVIDd、LVIDs低于对照组,FS、LVEF高于对照组(P<0.05)。观察组患者不良心血管事件发生率低于对照组(P<0.05)。结论阿托伐他汀联合替米沙坦治疗急性冠脉综合征介入治疗后并发糖尿病肾病的临床疗效确切,可有效改善患者急性肾损伤情况,保护肾功能,且安全性高。
Objective To investigate the clinical efficacy of atorvastatin combined with telmisartan in the treatment of diabetic nephropathy after interventional therapy of acute coronary syndrome. Methods 80 patients with acute coronary syndrome and diabetic nephropathy admitted to Hunan Want Want Hospital from May 2014 to May 2016 were divided into control group and observation group according to different treatment methods, 40 cases in each group. Patients in both groups received percutaneous coronary intervention (PCI) and adequate hydration therapy. Patients in the control group were treated with atorvastatin. Patients in the observation group were treated with telmisartan on the basis of the control group. Patients in both groups Continuous treatment for 2 weeks. The acute renal injury, serum lipids (triglyceride (TG) and total cholesterol (TC)], renal function indexes (serum creatinine, urine protein quantitation (UAE ), BUN, Cys C, and postoperative random urine microalbumin / creatinine (ACR) ratio], cardiac function parameters [left ventricular end-diastolic diameter (LVIDd), left ventricular end- (LVIDs), left ventricular fractional shortening (FS), left ventricular ejection fraction (LVEF) and the incidence of adverse cardiovascular events at follow-up of 6 months. Results There was no significant difference in the staging of acute kidney injury between the two groups before PCI (P <0.05). After 2 weeks of treatment, the acute kidney injury in observation group was better than that in control group (P <0.05). The levels of TC, TG, Scr, BUN, UAE and Cys C in the observation group and ACR in random urine were lower than those in the control group (P <0.05). LVIDd and LVIDs in the observation group were lower than those in the control group, while FS and LVEF were higher in the observation group than those in the control group (P <0.05). The incidence of adverse cardiovascular events in observation group was lower than that in control group (P <0.05). Conclusion Atorvastatin combined with Telmisartan in the treatment of acute coronary syndrome complicated with diabetic nephropathy after curative effect is effective, can effectively improve the patient’s acute kidney injury, protect renal function, and high safety.