厄贝沙坦辅助治疗糖尿病肾病的疗效及对患者肾功能、血清炎症细胞因子水平的影响

目的探讨厄贝沙坦辅助治疗糖尿病肾病的疗效及对患者肾功能和胰岛素样生长因子1 (insulin-like growth factor-1,IGF-1)、高迁移率族蛋白B1(high-mobility group box-1,HMGB1)、血管内皮生长因子165(vascular endothelial growth factor,VEGF165)水平的影响。方法前瞻性选取2016年5月~2018年5月马鞍山十七冶医院收治的糖尿病肾病患者86例,按照随机数表法分为对照组和观察组各43例。对照组于每餐前皮下注射门冬胰岛素30注射液,0.5~1.0 U/(kg·d),3次/d,并根据患者情况调整剂量;观察组在对照组的治疗基础上,予以厄贝沙坦150 mg,1次/d,口服。两组患者均连续治疗3个月,观察临床疗效,比较治疗前后两组患者空腹血糖(fasting plasmaglucose,FPG)、餐后2 h血糖(2 hours plasmaglucose,2hPG)和糖化血红蛋白(HbA1c)、血压、肾功能血包括血清肌酐(serum creatinine,Scr)、尿素氮(BUN)、同型半胱氨酸(Homocysteine,Hcy)、胱抑素C(cystain C,Cys C)]及IGF-1、HMGB1、VEGF165水平。结果两组治疗后总有效率对比,观察组高于对照组(93.02%vs.74.42%),差异有统计学意义(P <0.05)。治疗后,观察组FPG、2hPG、HbA1C、收缩压、舒张压、Scr、BUN、Hcy及Cys C水平明显低于对照组,观察组血清IGF-1、HMGB1、VEGF165水平明显低于对照组,差异有统计学意义(P <0.05)。结论厄贝沙坦联合门冬胰岛素30注射液治疗糖尿病肾病可提高临床疗效,降低血糖和血压水平,改善肾功能及血清炎性细胞因子水平。

Efficacy of irbesartan in the treatment of diabetic nephropathy and its effect on renal function and serum inflammatory cytokines in patients with diabetic nephropathy

Objective To investigate the efficacy of irbesartan in the treatment of diabetic nephropathy and its effect on renal function and the levels of insulin-like growth factor 1(IGF-1),high mobility group protein B1(HMGB1)and vascular endothelial growth factor 165(VEGF165). Methods 86 patients with diabetic nephropathy treated in our hospital from May 2016 to May 2018 were randomly divided into control group(n = 43)and observation group(n = 43).The control group was subcutaneously injected with insulin aspart 30 injection with 0.5 × 1.0 U/(kg·d),3 times a day before each meal,and the dose was adjusted according to the condition of the patients,while the observation group was given 150 mg irbesartan once a day on the basis of treatment in the control group. Patients in both groups were treated continuously for 3 months.The clinical effects of the two groups were observed,and the levels of fasting blood glucose(FPG),2-hour postprandial blood glucose(2 hPG)and glycosylated hemoglobin(HbA1 c),blood pressure,renal function serum creatinine(serum creatinine,Scr),urea nitrogen(BUN),homocysteine(Hcy),Cysteine C(Cys C)]and levels of IGF-1,HMGB1 and VEGF165 were compared between the two groups before and after treatment. Results There was significant difference in the total effective rate between the two groups after treatment(P < 0.05).The total effective rate in the observation group was higher than that in the control group(93.02% vs 74.42%).After treatment,the levels of FPG,2 hPG,HbA1 C,systolic blood pressure,diastolic blood pressure,Scr,BUN,Hcy and Cys C in the observation group were significantly lower than those in the control group.,and the serum levels of IGF-1,HMGB1 and VEGF165 in the observation group were significantly lower than those in the control group(P < 0.05). Conclusion Irbesartan combined with insulin aspart 30 injection can improve the clinical efficacy,reduce the level of blood glucose and blood pressure,and improve the level of renal function and serum inflammatory cytokines in patients with diabetic nephropathy.