目的 探讨前列地尔联合缬沙坦对糖尿病肾病（DN）患者氧化应激水平、尿钠排泄及血管内皮活性的影响。方法 选取武汉市第一医院门诊与病房2021年11月—2022年10月期间收治的DN患者98例。根据治疗方案不同，分为对照组（49例）和试验组（49例）。对照组给予缬沙坦治疗，试验组给予前列地尔联合缬沙坦治疗，比较两组治疗前后氧化应激指标水平[晚期氧化蛋白产物（AOPP）、丙二醛（MDA）、超氧化物歧化酶（SOD）]，比较治疗前后两组肾功能情况[肌酐（Scr）、尿素氮（BUN）、24 h尿微量白蛋白定量（MALB）]；比较两组治疗前后24 h尿钠及血浆肾素、醛固酮水平情况；比较治疗前后两组血管内皮活性情况[血管内皮生长因子（VEGF）、一氧化氮（NO）、内皮素-1（ET-1）]；观察两组临床疗效及不良反应情况。结果 治疗后，两组AOPP、MDA降低，SOD水平上升，且试验组低于对照组（P＜0.05）；治疗后，两组肌酐Scr、BUN、MALB水平降低，试验组更明显（P＜0.05）；治疗后，两组24 h尿钠升高，肾素、醛固酮水平降低，且试验组更明显（P＜0.05）；治疗后，两组VEGF、ET-1水平下降，NO水平升高，且试验组更明显（P＜0.05），试验组疗效优于对照组（P＜0.05），两组不良反应无明显差异（P＞0.05）。结论 前列地尔联合缬沙坦治疗DN的疗效满意，可有效降低患者氧化应激水平，提高其尿钠排泄，改善内皮功能，且安全性较高，值得临床推广应用。

Objective To investigate the effects of alprostadil combined with valsartan on oxidative stress, urinary sodium excretion and vascular endothelial activity in patients with diabetes nephropathy (DN). Methods A total of 98 DN patients admitted to outpatient and ward in Wuhan First Hospital from November 2021 to October 2022. According to different treatment schemes, they were divided into control group (49 cases) and experimental group (49 cases). The control group was treated with valsartan, and the experimental group was treated with alprostadil combined with valsartan. The levels of oxidative stress [advanced oxidation protein products (AOPP), malondialdehyde (MDA), superoxide dismutase (SOD)] before and after treatment were compared between the two groups, and the renal function [creatinine (Scr), urea nitrogen (BUN), 24-hour urine microalbumin (MALB)] before and after treatment were compared between the two groups. The levels of urinary sodium, plasma renin and aldosterone at 24 hours before and after treatment were compared between the two groups. The activity of vascular endothelial cells (VEGF, NO, ET-1) in the two groups were compared before and after treatment. The clinical efficacy and adverse reactions of the two groups were observed. Results After treatment, the levels of AOPP and MDA decreased and the levels of SOD increased in the two groups, and the experimental group was lower than the control group (P＜0.05). After treatment, the levels of creatinine Scr, BUN and MALB decreased in the two groups, which was more obvious in the experimental group (P＜0.05). After treatment, the urinary sodium increased and the levels of renin and aldosterone decreased in the two groups at 24 hours, which was more obvious in the experimental group (P＜0.05). After treatment, the levels of VEGF and ET-1 decreased and the levels of NO increased in the two groups, which were more obvious in the experimental group (P＜0.05). The curative effect of the experimental group was better than that of the control group (P＜0.05), and there was no significant difference in the adverse reactions between the two groups (P＞ 0.05). Conclusion The efficacy of alprostadil combined with valsartan in the treatment of diabetes nephropathy is satisfactory, which can reduce the level of oxidative stress in patients, increase their urinary sodium excretion, improve endothelial function, and has high safety, and is worthy of clinical application.

R977

湖北省卫生健康委员会科研项目（WJ2018F038）