目的 探讨前列地尔序贯治疗糖尿病肾病的临床疗效和安全性.方法 选取2009年7月—2014年7月朝阳市第二医院内分泌科收治的2型糖尿病且初次诊断为糖尿病肾病临床前期患者116例,随机分为对照组(38例),前列地尔组(39例)和前列地尔序贯组(39例).对照组给予常规治疗方案,前列地尔组在对照组基础上第1、2周加用前列地尔注射液,静脉滴注,2 mL/次,1次/d,第3、4周继续常规治疗.前列地尔序贯组第1、2周治疗方法同前列地尔组,第3、4周采用常规治疗联合口服贝前列素钠片,1片/次,3次/d.3组患者均连续治疗4周.比较3组治疗前后总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)尿素氮(BUN)、肌酐(Cr)、24 h尿微量白蛋白(24 h UMA)、总蛋白、24 h尿6-酮前列素F1α(6-keto-PGF1α)、血栓素B2和肾动脉血管阻力指数的变化情况.结果 治疗后,3组TC、TG、LDL-C、24 h UMA、尿总蛋白、Cr、BUN、血栓素B2、肾动脉阻力指数均显著降低,HDL-C、24 h尿6-keto-PGF1α显著升高,同组治疗前后差异有统计意义(P<0.05).且治疗后,前列地尔组、前列地尔序贯组这些指标改善程度优于对照组,而前列地尔序贯组优于前列地尔组,差异有统计学意义(P<0.05).结论 前列地尔序贯治疗糖尿病肾病具有较好的临床疗效,可明显改善患者血脂水平和肾功能,同时还可升高24 h尿6-keto-PGF1α,降低血栓素B2和肾动脉阻力指数,值得临床推广应用.

Objective To investigate the curative effect and safety of sequential therapy of alprostadil in treatment of diabetic nephropathy. Methods Patients suffered from diabetic nephropathy from July 2009 to July 2014 in the Second Hospital of Chaoyang City (116 cases) were collected and randomly divided into control (38 cases), alprostadil (39 cases), and alprostadil sequential (39 cases) groups. Patients in the control group were given conventional treatment. Patients in the alprostadil group were iv administered with Alprostadil Injection in the first two weeks, 2 mL/time, once daily, and accepted conventional treatment in the third and fourth weeks. The treatment in the alprostadil sequential group were the same as the alprostadil group in the first two weeks, and the patients in alprostadil sequential group were po administered with Beraprost Sodium Tablets, 1 tablet/time, three times daily. The patients in three groups were treated for 4 weeks. The changes of TC, TG, HDL-C, LDL-C, BUN, Cr, 24 h UMA, total protein, 24 h 6-keto-PGF1α, thromboxane B2, and resistance indexes of renal artery in three groups were compared. Results After treatment, TC, TG, LDL-C, 24 h UMA, total protein, Cr, BUN, thromboxane B2, and resistance indexes of renal artery in three groups were significantly reduced, HDL-C and 24 h 6-keto-PGF1α were significantly increased, and the differences were statistically significant before and after treatment in the same group (P < 0.05). After treatment, these indexes in the alprostadil and alprostadil sequential groups improved better than those of control group, while the indexes in the alprostadil group improved better than those of alprostadil . Conclusion Sequential therapy of alprostadil has good clinical effect in treatment of diabetic nephropathy, and can obviously improve the level of blood lipid and renal function, at the same time can also elevate 24 h 6-keto-PGF1α and reduce thromboxane B2 and resistance index of renal artery, which is worthy of clinical application.

国家自然科学基金资助项目(81000329)