雷公藤多甙联合奥美沙坦脂治疗早中期糖尿病肾病的临床观察

目的观察雷公藤多甙治疗早中期糖尿病肾病（DN）的临床疗效。方法将80例早中期DN患者随机分为治疗组45例、对照组35例,两组患者均口服奥美沙坦脂。治疗组在此基础上加服雷公藤多甙。观察两组患者治疗前后尿白蛋白排泄率（UAER）、尿β2微球蛋白（β2-MG）、单核细胞趋化因子（MCP-1）、血清白蛋白（ALB）、血肌酐（SCr）和谷丙转氨酶（ALT）等指标变化。结果治疗组的总有效率为84.44%,对照组的总有效率为54.29%,治疗组的疗效较对照组好,差异有统计学意义（P〈0.01）。治疗后两组UAER、β2-MG和MCP-1水平较治疗前出现明显下降（P〈0.05或〈0.01）,但治疗组下降更为明显,与对照组比较差异有统计学意义（P〈0.01）。仅治疗组SCr较治疗前和对照组出现明显下降（P〈0.01）,而治疗组ALB水平较对照组和治疗前出现明显提高,差异有统计学意义（P〈0.01）。两组治疗前后的ALT水平差异无统计学意义（P〉0.05）。结论雷公藤多甙联合奥美沙坦酯治疗DN疗效显著,其机理可能与降低MCP-1水平有关,并且毒副作用较小。

Clinical efficacy of the early metaphase diabetic nephropathy treated with tripterygium glycosides combined with olmesartan

Objective To observe the clinical efficacy of the early and mid diabetic nephropathy（DN） treated with tripterygium glycosides combined with olmesartan. Methods 80 patients with early and mid DN were randomly divided into treatment group （45 cases） and control group （35 cases）,and all received with oral treatment of olmesartan,and the treatment group also treated with tripterygium glycosides. Urinary albumin excretion rate （UAER）, urinary β2-microglobulin （β2-MG） level, monocyte chemoattractant protein-1 （MCP-1） level, serum albumin （ALB） level, serum creatinine （SCr） level and alanine aminotransferase （ALT） level were measured before and after treatment. Results The total effective rate was 84.44% in treatment group, and was 54.29% in the control group. The efficacy of the treatment group was better than that of control group, with significant difference （P〈0.01）. After treatment, the levels of UAER, β2-MG and MCP-1 were significantly decreased compared with those before treatment （P〈0.05 or 0.01）, but in the treatment group, the decreased was significantly more than the control group （P〈0.01）, while the levels of SCr were decreased more significantjly than those before and control group（P〈0.01）. The level of ALB in the treatment group significantly increased more than those before treatment and in the control group （P〈0.01）. The levels of ALT in both groups were not significant different between before and after treatment （P〉0.05）. Conclusion The efficacy of DN treated with tripterygium glycosides combined with olmesartan was obvious, and its mechanism may be via the reduction of MCP-1 level. The side effect of this combined treatment is less.