目的 探讨雷米普利与低分子量肝素钙联合用药治疗老年糖尿病肾病的疗效和作用机制。方法 选取2013年4月—2014年4月上海市浦东医院收治的糖尿病肾病患者78例, 随机分为两组, 治疗组给予雷米普利片, 口服, 2.5 mg/次, 2次/d, 同时sc给予低分子量肝素钙注射液, 5 000 U/次, 1次/d;对照组仅sc给予低分子量肝素钙注射液5 000 U/次, 1次/d。治疗4周后评价两组的血压、肾功能、凝血功能变化、抗氧化指标和疗效。结果 治疗后, 对照组尿白蛋白排泄率(UAER)、24 h尿蛋白、血尿素氮(BUN)、收缩压与治疗前比较差异具有统计学意义(P<0.01), 治疗组UAER、24 h尿蛋白、肌酐(Cr)、BUN、纤维蛋白原(FIB)、血压与治疗前比较差异均具有统计学意义(P<0.01), 且与对照组比较差异具有统计学意义(P<0.01);治疗组与对照组在丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽(GSH)和过氧化氢酶(CAT)比较差异具有统计学意义(P<0.05、0.01);治疗组的有效率为89.74%, 对照组的为79.49%, 两组比较差异具有统计学意义(P<0.05)。 结论 雷米普利与低分子肝素钙联合用药能够改善机体酶性抗氧化系统对自由基清除, 从而提高对老年糖尿病肾病的疗效。

Objective To investigate the efficacy and mechanism of ramipril combined with low molecular weight heparin calcium in treatment of elderly diabetic nephropathy. Methods Patients (78 cases) with diabetic nephropathy in Shanghai Pudong Hospital from April 2013 to April 2014 were randomly divided into two groups. The patients in the control group were sc administered with Low Molecular Heparin Calcium Injection 5 000 U/time, once daily. Patients in treatment group were po administered with Ramipril Tablets on the basis of control group, 2.5 mg/time, twice daily. Blood pressure, renal function, blood coagulation function, anti-oxidant index, and efficacy were evaluated after 4 weeks. Results After treatment, the UAER, 24 h urinary protein, BUN, and systolic blood pressure in control group were significantly improved, and the difference was statistically significant before and after the treatment in the same group (P < 0.01). The UAER, 24 h urinary protein, Cr, BUN, FIB, blood pressure in treatment group were improved, and the difference was statistically significant before and after the treatment in the same group (P < 0.01), and there was significant difference between the two groups (P < 0.01). The levels of MDA, SOD, GSH and CAT between treatment group and control group were statistically significant (P < 0.05, 0.01). The efficacy in the control and treatment groups was 89.74% and 79.49%, respectively, and there were differences between two groups (P < 0.05). Conclusion Ramipril combined with low molecular weight heparin calcium can improve the body enzymatic antioxidant system, so as to improve the efficacy of diabetic nephropathy.

上海市浦东新区卫生系统重点学科建设资助项目(PWZx2014-11);上海市浦东新区医学领先人才项目(PWRI2012-05);复旦大学优势建设学科资助项目