摘要
目的 研究达格列净和非奈利酮联合使用对慢性肾脏病(CKD)患者肾小球和肾小管功能标志物的影响.方法 将2022年9月至2024年1月滁州市中西医结合医院收治的80例CKD患者纳入本次前瞻性研究,根据随机数字表法将其分为联合组(n=40)和对照组(n=40).联合组患者接受达格列净和非奈利酮治疗,对照组患者接受达格列净治疗,治疗周期为4周.比较两组患者的临床疗效及治疗前、治疗4周后的尿β-2微球蛋白(Uβ2-MG),尿微量白蛋白(UmAlb),尿N-乙酰-β-D氨基葡萄糖甘酶(UNAG),尿视黄醇结合蛋白(URBP),尿免疫球蛋白G(UIgG)和血清胱抑制C(CysC)、血肌酐、尿素氮和肾小球滤过率(GFR)、血钾、钙和磷水平以及不良反应发生情况.结果 治疗4周后,联合组的总有效率为95.00％,显著高于对照组(80.00％),差异有统计学意义(P＜0.05).治疗4周后,联合组的 Uβ2-MG、UmAlb、UNAG、URBP 和 UIgG 水平分别为(2.09±0.78)mg/L、(29.08±6.75)mg/L、(6.02±1.49)U/L、(2.19±0.71)mg/L 和(32.70±6.15)mg/L,均显著低于对照组[(3.18±0.91)mg/L、(39.64±7.13)mg/L、(7.93±1.64)U/L、(3.65±1.02)mg/L和(40.97±6.76)mg/L],差异均有统计学意义(P＜0.05).治疗4周后,联合组的血清 CysC、血肌酐和尿素氮分别为(0.95±0.42)mg/L、(101.62±12.87)µmol/L 和(5.98±0.59)mmol/L,均显著低于对照组[(1.39±0.53)mg/L、(110.07±13.04)μmol/L 和(7.74±0.67)mmol/L],而 GFR 为(65.17±6.18)mL·min-1·1.73m-2,显著高于对照组[(58.59±6.02)mL·min-1·1.73 m-2],差异均有统计学意义(P＜0.05).治疗 4周后,两组的血钾、钙和磷水平比较,差异均无统计学意义(P＞0.05).两组不良反应总发生率比较,差异无统计学意义(P＞0.05).结论 达格列净联合非奈利酮治疗CKD患者的疗效更佳,可明显改善肾小球和肾小管功能,保护肾脏,且安全性良好.
Abstract
Objective To explore the effects of the treatment of dapagliflozin combined with finerenone on glomerular and tubular func-tional markers in patients with chronic kidney disease(CKD).Methods Eighty patients with CKD admitted to Chuzhou Integrated Traditional Chinese and Western Medicine Hospital from September 2022 to January 2024 were included in this prospective study and were randomly divided into the combination group(n=40)and the control group(n=40)according to the random number table method.Patients in the combination group received treatment with dapagliflozin and finerenone,while patients in the control group received treatment with dapagliflozin,with a treat-ment period of 4 weeks.The clinical efficacy,urine β-2 microglobulin(Uβ2-MG),urinary microalbumin(UmAlb),urinary N-acetyl-β-D-glucosamine glycosylase(UNAG),urinary retinol binding protein(URBP),urinary immunoglobulin G(UIgG),serum cystatin C(CysC),serum creatinine,urea nitrogen,glomerular filtration rate(GFR),blood K,Ca and P before treatment and after 4 weeks of treatment,and inci-dence of adverse reactions were compared.Results After 4 weeks of treatment,the total effective rate of the combination group was 95.00％,which was significantly higher than that of the control group(80.00％),and the difference was statistically significant(P＜0.05).After 4 weeks of treatment,the levels of Uβ2-MG,UmAlb,UNAG,URBP and UIgG in the combination group were(2.09±0.78)mg/L,(29.08±6.75)mg/L,(6.02±1.49)U/L,(2.19±0.71)mg/L and(32.70±6.15)mg/L,respectively,which were significantly lower than those in the control group[(3.18±0.91)mg/L,(39.64±7.13)mg/L,(7.93±1.64)U/L,(3.65±1.02)mg/L and(40.97±6.76)mg/L],the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the serum CysC,serum creatinine and urea nitrogen in the combination group were(0.95±0.42)mg/L,(101.62±12.87)μmol/L and(5.98±0.59)mmol/L,respectively,which were significantly lower than those in the control group[(1.39±0.53)mg/L,(110.07±13.04)μmol/L and(7.74±0.67)mmol/L],while the GFR was(65.17±6.18)mL·min-1·1.73 m-2,which was significantly higher than that of the control group[(58.59±6.02)mL·min-1·1.73 m-2],the differences were statistically significant(P＜0.05).There were no statistically significant differences in blood K,Ca,and P between the two groups after 4 weeks of treatment(P＞0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion The combination of dapagliflozin and phenidate has a better therapeutic effect on patients with chronic kidney disease,significantly improving glomerular and tubular function,protecting the kidneys,and having good safety.
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