前列地尔联合氯吡格雷治疗早期糖尿病肾病临床疗效观察

目的观察前列地尔注射液联合氯吡格雷治疗早期糖尿病肾病的疗效。方法选择60例早期糖尿病肾病患者,均使用血管紧张素受体拮抗剂（ARB）或血管紧张素转化酶抑制剂（ACEI）类药物1个月以上。随机分为治疗1组和治疗2组,治疗1组给予前列地尔,治疗2组给予前列地尔联合氯吡格雷,疗程为20d,比较治疗前后患者尿微量白蛋白量（U-malb）、β2-微球蛋白（β2-MG）、高敏C反应蛋白（hs-CRP）、全血粘滞度、血浆粘滞度、血小板聚集率、血肌酐（Cr）、尿素氮（Bu N）、平均动脉压（MPA）的变化。结果两组治疗前后的U-malb、β2-MG、hs-CRP、全血粘滞度、血浆粘滞度、血小板聚集率均明显下降（P〈0.05）;治疗2组较治疗1组上述指标下降程度有统计学意义（P〈0.05）,两组治疗前后Cr、Bu N、MPA均无明显变化（P〉0.05）。结论前列地尔联合氯吡格雷治疗早期糖尿病肾病在使用ACEI或ARB基础上进一步降低尿白排出,减轻炎症反应,延缓了糖尿病肾病的进展,两者有协同治疗糖尿病肾病作用。

Clinical effect of alprostadil combined with clopidogrel on treating early diabetic nephropathy

Objective To observe the effect of alprostadil combined with clopidogrel on treating early diabetic nephropa- thy （DN）. Methods Selected 60 cases with early diabetic nephropathy used angiotensin receptor blocker （ARB） or an- giotensin converting enzyme inhibitors （ACEI） drugs above 1 months, then randomly divided into trial group 1 （n=30） and trail group 2 （n=30）. The patients in trial group 1 were given alprostadil only for 20d, trial group 2 were given alprostadil and clopi- dogrel for 20d. Before and after the study, the changes of Urinary micro album excretion （U-malb）, ~2-macroglobulin （~52- MG）, hypersensitive3 C-reactive protein（hs-CRP）,whole blood viscosity, plasma viscosity, the platelet aggregation rate, crea- tinine（Cr）,blood urea nitrogen（BuN）, mean arterial pressure （MPA） were compared. Results U-malb,~2-MG, hs-CRP, whole blood viscosity, plasma viscosity and the platelet aggregation rate after treatment decreased than before. There were sinificant differences between 2 groups （P〈0.05）. There were no statistically significant diference between the two groups in Cr, BUN, MPA （P〉0.05）. Conclusion Alprostadil joint clopidogrel in the treatment of early diabetic nephropathy can reduce the U- malb excretion and reduce inflammation, retard the progression of diabetic nephropathy, both appear to play a synergy.