前列腺素E1治疗糖尿病肾病的短期与长期疗效观察

目的 观察前列腺素E1(PGEl)治疗糖尿病肾病的短期与长期疗效. 方法 根据Mogensen糖尿病肾病诊断标准,对糖尿病肾病患者进行分期,分为Ⅲ、Ⅳ(早期、中期、晚期)、Ⅴ期;各期患者再随机分为4组:PGE1组、PGE1+血管紧张素转换酶抑制剂(ACEI)组、ACEI组和对照组.测定各组治疗前及治疗后15 d、6个月、18个月时24 h尿蛋白和24 h尿微量白蛋白水平. 结果 (1)治疗后15 d,各期PGEl+ACEI组和PGE1组患者尿蛋白及尿微量白蛋白均较治疗前显著下降(P<0.01),且疗效明显好于ACEI组(P<0.01);(2)治疗后6个月,Ⅲ、Ⅳ期PGE1+ACEI组和PGE1组中上述指标与治疗后15 d相似,Ⅴ期PGE1+F ACEI组较治疗前下降(P<0.05),但PGE1组和ACEI组与治疗前比较,差异无统计学意义(P>0.05);(3)治疗后18个月,Ⅲ期和Ⅳ早期各治疗组上述指标较治疗前显著下降(P<0.01),IV中、晚期PGE1+ACEI组仍较治疗前下降(P<0.01或P<0.05),且疗效好于ACEI组(P<0.01或P<0.05),IV晚期PGE1组尿蛋白较治疗前升高(P<0.05);V期各治疗组均较治疗前升高(P<0.01). 结论 PGE1对糖尿病肾病具有较好的短期疗效,而且早期疗效优于晚期;PGE1与ACEI联合应用,长期疗效优于单用PGE1或ACEI,建议糖尿病肾病患者每6个月使用PGE1治疗1个疗程.

Short and long term therapeutic effects of prostaglandin El treatment on diabetic nephropathy

Objective To investigate the short and long term therapeutic effects of prostaglandin E1 (PGEl) on diabetic nephropathy (DN). Methods Patients with DN in stage Ⅲ to Ⅴ according to Mogensen criteria were randomly assigned to four groups of PGE1, angiotensin-converting enzyme inhibitor (ACEI), PGE1 + ACEI and control drug. The levels of proteinuria and albuminuria were measured before and 15 days, 6 months and 18 months after treatment. Patients with DN in stage Ⅳ were subdivided into three groups according to proteinuria: early stage IV (protienuria was less than 1.5 g/d), middle stage Ⅳ (protienuria was between 1.5 g/d and 2.5 g/d) and late stage Ⅳ (protienuria was larger than 2.5 g/d). Results Fifteen days after treatment, the levels of proteinuria and albuminuria were significantly decreased compared with pre-treatment in PGE1 and PGE1 + ACEI groups (P<0. 01), and the therapeutic effect was better in PGE1 + ACE1 group than in ACEI group (P<0. 01). Six months after treatment, there were still significant differences in above parameters in patients with DN in stage Ⅲ and Ⅳ between PGE1 + ACEI and PGE1 groups. And for the patients in stage Ⅴ, statistic significance between pre-and post-treatment existed only in PGE1 + ACEI group (P<0. 05). but not in PGE1 and ACEI groups (both P>0. 05). Eighteen months atter treatment, the levels of proteinuria and albuminuria were significantly decreased in patients in stage HI and early stage IV in all treatment groups (P<0. 01). For patients in middle stage IV and late stage Ⅳ , the significant differences still occurred between pre-and post-treatment in PGE1 + ACEI group (P<0. 01 or P<0. 05), and were significantly better than in ACEI group (P<0. 01 or P<0. 05). However, the proteinuria of patients in late stage IV elevated in PGE1 group in post-treatment versus pre-treatment (P<0. 05). Conclusions The short term therapeutic effect of PGE1 is quick and good in patients with DN. The therapeutic effect is much better in patients in stage Ⅲ compared with stage Ⅴ. The combination of PGE1 and ACEI will get better best therapeutic effect than PGE1 or ACEI alone in long term.