摘要:目的: 观察低分子肝素联合ACEI/ARB治疗糖尿病肾病(DN)的疗效。 方法 :将55例2型DN患者随机分为对照组(ACEI/ARB)和治疗组(ACEI/ARB+低分子肝素),疗程8周。比较两组治疗前和治疗后24h尿蛋白,Scr、BUN、血浆白蛋白等指标的变化。 结果 :(1)治疗后治疗组和对照组24h尿蛋白、Scr均显著下降(〖WTBX〗P lt;001,〖WTBX〗P lt;005),治疗组比对照组下降更为明显(〖WTBX〗P lt;005)。(2)治疗后两组血浆白蛋白均增加(〖WTBX〗P lt;001),治疗组与对照组治疗后比较无明显差异(〖WTBX〗P gt;005)。(3)治疗后两组BUN均降低(〖WTBX〗P lt;005),治疗组与对照组治疗后比较无明显差异(〖WTBX〗P gt;005)。(4)治疗后两组TC和TG均无明显变化。 结论 :联合应用低分子肝素能有效减少DN患者的蛋白尿,改善肾功能。Abstract: Objective: To study the clinical effects of lowmolecularweight heparin (LMWH) and ACEI/ARB on diabetic nephropathy(DN).Methods :55 patients of type 2 Diabetic nephropathy were randomly divided into treatment group(ACEI/ARB+ LMWH)and control group (ACEI/ARB).SCr,quantity of protein in 24hour urine,BUN and plasma albumin figures were compared between two groups before treatment and eight weeks after treatment.Results :(1)SCr,quantity of protein in 24hour urine had been decreased significantly in both groups(P lt;001,P lt;005),and more significantly in treated group than in control group (P lt;005).(2)Plasma albumin increased significantly in both groups(P lt;001).But no significantly increase of plasma albumin had been found in treatment group during the followup(P gt;005).(3)BUN decreased significantly in both groups(P lt;005), but no significantly decrease of BUN had been found in treatment group during the followup(P gt;005).(4)There were no significantly difference in TC and TG between two groups.Conclusion : LMWH and ACEI/ARB can ameliorate proteinuria and improve renal function of the patients with DN.
目的:观察苯那普利联合银杏达莫注射液对糖尿病肾病(DN)患者蛋白尿、肾功能以及血液流变学指标的影响。方法:75例2型糖尿病肾病患者随机分为对照组和治疗组,对照组给予饮食控制、降糖、降脂等常规治疗,对照组在常规治疗基础上给与苯那普利和银杏达莫注射液治疗,疗程共12周,分别观察治疗前后两组患者空腹血糖、血脂和肾功能以及UAER和血液流变学参数的变化。结果:治疗12周后,两组患者空腹血糖控制良好,治疗组患者UAER较对照组明显下降,分别为314.62±49.83 mL/min和282.97±36.62 mL/min,治疗组患者肾功能和血液流变学参数较治疗前明显改善(Plt;0.05)。结论:苯那普利联合银杏达莫注射液能明显改善糖尿病肾病患者血液流变学参数,提高肾脏功能,减少24 h尿蛋白。
Objective To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria. Methods According to the patient’s clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly. Results Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient’s specific condition. The patient is still being followed-up. Conclusion Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.
Objective To assess the effectiveness and safety of breviscapine on diabetic nephropathy. Methods All randomized or quasi-randomized controlled trials of breviscapine on diabetic nephropathy were performed. All of the clinical trials were searched from the Cochrane Controlled Trials Registered, Medline, Embase, National Knowledge Infrastructure Database, the Chinese Biological Medicine Database, the Chinese Science and Technology Journal Full-text and the references of all included trials. The selection of studies, assessment of methodological quality and data extraction were performed independently by two reviewers according to predefined inclusion and exclusion criteria. Results Thirty-three clinical trials including 2 322 patients of diabetic nephropathy met the inclusion criteria. But most included trials were of low quality and small sample. Until now, there were no clinical trials with multicentre, large sample and high quality. A “Funnel plot” showed asymmetry, which indicated possible publication bias and low quality in methodology. And publication bias showed that the trials with negative results might not be published. The results of meta-analysis indicated that: 1. Breviscapine showed more effects on the decrease of the 24-hour urinary albumin excretion rate (UAER), 24-hour urinary protein, serum creatinine (Scr), total cholesterol, triglyceride, plasma viscosity and fibrinogen. 2. Breviscapine showed less effect on the decrease of the 24-hour urinary protein when compared to angiotensin-converting enzyme inhibitor, it seemed as same effective as ACEI on decrease of 24-hour urinary albumin excretion rate (UAER), serum creatinine (Scr) and blood urea nitrogen (BUN); 3. Breviscapine showed more effect on the decrease of 24-hour urinary protein and fibrinogen when compared to other Chinese herbal medicine (Salvia miltiorrhiza); 4. Breviscapine showed less effect on decrease of the 24-hour urinary albumin excretion rate (UAER) when compeard to Prostaglandin E1. No significant adverse effects were reported. Conclusion Breviscapine shows some effects and relatively safe on diabetic nephropathy. However, the evidence is not b enough because of some of the low-quality trials and publications bias. Rigorous designs, randomized, double-blind, placebo-controlled trials of Breviscapine for diabetic nephropathy are needed to further assess the effect.
【摘要】 目的 探讨灯盏花素注射液联合血管紧张素转换酶抑制剂（ACEI）依那普利治疗糖尿病早期肾病的临床效果。 方法 2006年10月-2009年12月，将59例临床确诊2型糖尿病早期肾病的患者随机分为治疗组（n=30）与对照组（n=29）。对照组在基本治疗的基础上应用依那普利，治疗组在基本治疗的基础上联合应用依那普利和灯盏花素注射液，疗程均为3周。观察治疗前后两组患者24 h尿微量白蛋白排泄率（UAER）、全血黏度、血浆黏度、甘油三酯（TG）、尿素氮（BUN）、血肌酐（SCr）的变化。 结果 两组患者治疗前后自身对比，24 h UAER均有明显下降（Plt;0.05）；治疗组UAER下降较对照组更为明显（Plt;0.05）。 结论 ACEI联合灯盏花素，其降低24 h UAER疗效优于单纯ACEI疗效，还可有效降低全血黏度和血浆黏度，降低纤维蛋白原含量，改善患者血液流变性。【Abstract】 Objective To investigate the therapeutic effects of breviscapine combined with angiotensin converting enzyme inhibitor (enalapril) on early diabetic nephropathy. Methods A total of 59 patients with early diabetic nephropathy diagnosed between October 2006 and December 2009 were randomly divided into treatment group (n=30) and control group (n=29). The patients in treatment group were treated by breviscapine combined with enalapril, while the patients were treated with only enalapril in the control group. All of the patients were treated for three weeks. Urinaryalbuminexcretion (UAE), whole blood viscosity, plasma viscosity, triglycercide, blood urea nitrogen and serum creatinine in the two groups were detected before and after the treatment. Results After the threatment, UAE decreased in both of the two groups compared with the value before the treatment (Plt;0.05); the decrease in treatment groups was more obvious than that in the control group (Plt;0.05). Conclusion The combination of breviscapine and enalapril is effective on early diabetic nephropathy.
目的:观察脂微球前列腺素E1联合氯沙坦对糖尿病肾病(DN)患者24 h蛋白尿和肾功能的影响。方法:63例2型糖尿病肾病患者随机分为对照组和治疗组,两组患者均给予适量运动、饮食控制、降糖、降脂等常规治疗,对照组在常规治疗基础上给予氯沙坦治疗,而治疗组则同时给予脂微球前列腺素E1和氯沙坦,疗程共12周,分别观察治疗前后两组患者空腹血糖、肾功能及24 h尿蛋白的变化。结果:治疗12周后,两组患者空腹血糖控制良好,治疗组患者肾功能较治疗前明显改善(Plt;005),且尿白蛋白排泄率较对照组明显下降,分别为（32212±5021） mL/min和（27657±3812） mL/min,两者间的差异具有显著性意义。结论:脂微球前列腺素E1联合氯沙坦能明显改善糖尿病肾病患者肾脏功能,减少24 h尿蛋白。
Objective To assess the efficacy of Tongxinluo for diabetic kidney disease. Methods we conducted a systematic review of randomized controlled trials (RCTs) in which Tongxinluo was used to treat diabetic kidney disease. And we screened relevant studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by using The Cochrane Collaboration’s Revman 5.0 software. Results A total of 11 RCTs were enrolled in the review. The results of meta-analysis showed that Tongxinluo was better on attenuating 24 hour urinary protein,BUN and UAER; Tongxinluo was not superior to no treatment on the improvement of Scr and Ccr; Tongxinluo was better than no treatment on the Regulation of blood lipids, such as TC, TG, LDL-C. However, Tongxinluo might have similar effects on the improvement of HDL-C; Tongxinluo was better than no treatment on the improvement of FBG, but xuezhikang was not superior to no treatment on the improvement of P2BG and HbA1c. Tongxinluo was better than no treatment in decreasing plasma endothelin (ET). No significant adverse effects or Allergic reactions were reported. Conclusion The evidence currently available shows that Tongxinluo has some effect and is relatively safe in treating patients with diabetic kidney disease.Due to a high risk of selection bias and detection bias in the included studies, the evidence is insufficient to determine the effect of Tongxinluo. Further large-scale trials are required to define the role of xuezhikang in the treatment of DKD.