前列地尔联合吡格列酮对早期糖尿病肾病相关炎症因子的影响

目的观察前列地尔（凯时）联合吡格列酮对早期糖尿病肾病（DN）患者肿瘤坏死因子α（TNF-α）、脂联素水平的影响。方法收集门诊和住院的2型糖尿病患者79例,随机分为3组：单纯前列地尔组26例,单纯吡格列酮组27例,前列地尔注射液联合吡格列酮组26例。全部病例进行临床观察治疗2周。分别比较3组血压、血糖、糖化血红蛋白（HbA1c）、24小时尿微量白蛋白排泄率（24 hUAER）、TNF-α及脂联素水平治疗前后的变化。结果 3组在治疗前各项指标差异均无统计学意义（P〉0.05）,各组治疗2周后UAER、TNF-α及脂联素都较前有明显好转：前列地尔组UAER（245.12±28.69）mg vs（157.32±25.15）mg,TNF-α（1.56±0.42）ng/L vs（1.20±0.38）ng/L,脂联素（4.28±1.03）mg/L vs（7.65±2.56）mg/L,吡格列酮组UAER（252.76±27.65）mg vs（164.15±23.47）mg,TNF-α（1.64±0.39）ng/L vs（1.18±0.35）ng/L,脂联素（4.35±1.10）mg/L vs（7.81±2.14）mg/L,联合治疗组UAER（263.75±29.45）mg vs（113.24±19.35）mg,TNF-α（1.67±0.40）ng/Lvs（1.05±0.29）ng/L,脂联素（4.67±0.14）mg/L vs（9.45±2.46）mg/L（P〈0.01）,而联合治疗组的UAER、TNF-α及脂联素较另两组好转更明显：UAER（113.24±19.35）mg vs（157.32±25.15）mg、（164.15±23.47）mg,TNF-α（1.05±0.29）ng/L vs（1.20±0.38）ng/L、（1.18±0.35）ng/L,脂联素（9.45±2.46）mg/L vs（7.65±2.56）mg/L、（7.81±2.14）mg/L（P〈0.05）。结论前列地尔联合比格列酮治疗早期DN,能有效改善TNFα、脂联素并减少UAER,有利于延缓糖尿病肾病的发展。

Alprostadil combined with pioglitazone in treatment of diabetic nephropathy and relative inflammation factors

Objective To investigate the effect of alprostadil combined with pioglitazone on the level of tumor necrosis factor-α（TNF-α） and adiponectin in patients with early diabetic nephropathy.Methods Seventy-nine patients with type 2 diabetes collected from clinic service and in-patient department were separated randomly into three groups： alprostadil group 26 cases,pioglitazone group 27cases and alprostadil combined with pioglitazone group 26 cases.All cases were observed for two weeks to contrast separately the changes before and after therapy on the level of blood pressure,blood glucose,HbA1c,24 hUAER,TNF-α and adiponectin of three groups.Results Before therapy there was no obvious discrepancy on each index of three groups with comparability（P0.05）.UAER,TNF-α and adiponectin were all improved obviously after two weeks in each group：alprostadil group UAER（245.12±28.69） mg vs（157.32±25.15） mg,TNF-α（1.56±0.42） ng/L vs（1.20±0.38） ng/L,adiponectin（4.28±1.03） mg/L vs（7.65±2.56） mg/L,pioglitazone group UAER（252.76±27.65） mg vs（164.15±23.47） mg,TNF-α（1.64±0.39） ng/L vs（1.18±0.35） ng/L,adiponectin（4.35±1.10） mg/L vs（7.81±2.14） mg/L,combination therapy group UAER（263.75±29.45） mg vs（113.24±19.35） mg,TNF-α（1.67±0.40） ng/L vs（1.05±0.29） ng/L,adiponectin（4.67±0.14） mg/L vs（9.45±2.46） mg/L（P0.01）.UAER,TNF-α and adiponectin in the combination group showed greater improvement than the other two groups：UAER（113.24±19.35） mg vs（157.32±25.15） mg,（164.15±23.47） mg,TNF-α（1.05±0.29） ng/L vs（1.20±0.38） ng/L,（1.18±0.35） ng/L,adiponectin（9.45±2.46） mg/L vs（7.65±2.56） mg/L,（7.81±2.14） mg/L（P0.05）.Conclusion The therapy of alprostadil combined with pioglitazone can effectively improve TNF-α,adiponectin and reduce UAER,which can help to postpone the development of diabetic nephropathy.