摘要
目的 探讨非奈利酮联合达格列净治疗糖尿病肾病(DN)患者效果及其对临床症状、免疫功能的效果.方法 前瞻性选取2023年1月至2024年2月西安医学院第二附属医院收治的60例DN患者,按照随机数字表法将其分为观察组与对照组,每组各30例.对照组口服达格列净治疗,观察组在对照组基础上增加非奈利酮治疗.比较两组的临床疗效,治疗前、治疗4周后的临床症状(肾体积增大、肾小球滤过率增高、尿蛋白排除率增高、肾小球基膜广泛增厚、水肿)、免疫功能[CD4+、CD3+和CD4+/CD8+、免疫球蛋白(Ig)G及IgA]、微炎症状态相关指标[白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)]及心、肝、肾功能相关指标[B型利钠肽(BNP)、总胆红素(TBIL)、尿蛋白排泄率(UAER)、尿素氮]变化.结果 观察组治疗总有效率为96.67％,高于对照组(76.67％),差异有统计学意义(P＜0.05).治疗4周后,观察组患者肾体积增大、肾小球滤过率增高、尿蛋白排除率增高、肾小球基膜广泛增厚、水肿发生率分别为33.33％、20.00％、43.33％、10.00％、33.33％,均明显低于对照组(60.00％、46.67％、70.00％、33.33％、60.00％),差异均有统计学意义(P＜0.05).治疗 4 周后,观察组 CD4+、CD3+、CD4+/CD8+、IgG 及IgA 水平分别为(42.59±6.24)％、(67.58±6.12)％、1.65±0.35、(9.78±0.21)g/L、(1.81±0.52)g/L,均高于对照组[(34.12±7.52)％、(52.21±3.21)％、1.06±0.28、(9.58±0.26)g/L、(1.58±0.22)g/L],差异均有统计学意义(P＜0.05).治疗 4 周后,观察组患者 IL-6、TNF-α、hs-CRP 水平分别为(12.36±2.12)、(32.34±12.31)、(6.09±1.24)ng/L,均低于对照组[(16.49±3.19)、(46.17±10.23)、(9.67±2.38)ng/L],差异均有统计学意义(P＜0.05).治疗 4 周后,观察组 BNP、UAER、尿素氮水平分别为(414.73±43.12)ng/L、(63.62±11.24)mg/24 h、(9.16±1.42)mmol/L,均明显低于对照组[(517.76±63.46)ng/L、(106.25±17.32)mg/24 h、(10.31±1.37)mmol/L],差异均有统计学意义(P＜0.05);治疗4周后,两组患者TBIL水平比较,差异无统计学意义(P＞0.05).结论 非奈利酮联合达格列净治疗DN疗效显著,可改善患者临床症状,提升免疫功能,减轻微炎症反应,改善心功能与肾功能,对肝功能无明显不良影响.
Abstract
Objective To explore the effect of fenelidone combined with daggligin in the treatment of diabetes nephropathy(DN)and its effect on clinical symptoms and immune function.Methods Sixty patients with DN admitted to the Second Affiliated Hospital of Xian Medical U-niversity from January 2023 to February 2024 were prospectively selected and divided into the observation group and the control group according to the random number table method,with 30 cases in each group.The control group received oral treatment with dapagliflozin,while the observation group received additional treatment with phenidate in addition to the control group.The clinical efficacies,the changes of clinical symptoms(in-creased renal volume,increased glomerular filtration rate,increased urinary protein excretion rate,extensive thickening and edema of glomerular basement membrane),immune function[CD4+,CD3+and CD4+/CD8+,immunoglobulin(Ig)G and IgA],micro-inflammatory state related indicators[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP)]and heart,liver and kidney function related indicators[B-type natriuretic peptide(BNP),total bilirubin(TBIL),urinary albumin excretion rate(UAER),u-rea nitrogen]before and after 4 weeks of treatment of the two groups were compared.Results The total effective rate of treatment in the observa-tion group was 96.67％,which was higher than that in the control group(76.67％),and the difference was statistically significant(P＜0.05).After 4 weeks of treatment,the incidence of increased renal volume,increased glomerular filtration rate,increased urinary protein exclusion rate,extensive thickening of glomerular basement membrane,and edema in the observation group were 33.33％,20.00％,43.33％,10.00％,and 33.33％,respectively,which were significantly lower than those in the control group(60.00％,46.67％,70.00％,33.33％,60.00％),the differences were statistically significant(P＜0.05).After treatment,the levels of CD4+,CD3+,CD4+/CD8+,IgG,and IgA in the observa-tion group were(42.59±6.24)％,(67.58±6.12)％,(1.65±0.35),(9.78±0.21)g/L,and(1.81±0.52)g/L,respectively,which were higher than those in the control group[(34.12±7.52)％,(52.21±3.21)％,1.06±0.28,(9.58±0.26)g/L,(1.58±0.22)g/L],the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the levels of IL-6,TNF-α and hs-CRP in the observa-tion group were(12.36±2.12),(32.34±12.31),and(6.09±1.24)ng/L,respectively,which were lower than those in the control group[(16.49±3.19),(46.17±10.23),(9.67±2.38)ng/L],the differences were statistically significant(P＜0.05).After 4 weeks of treat-ment,the levels of plasma BNP,UAER,urea nitrogen in the observation group were(414.73±43.12)ng/L,(63.62±11.24)mg/24 h,and(9.16±1.42)mmol/L,respectively,which were lower those in the control group[(517.76±63.46)ng/L,(106.25±17.32)mg/24 h,(10.31±1.37)mmol/L],the differences were statistically significant(P＜0.05).Conclusion Feneridone combined with Daggligin has a significant effect in the treatment of DN,which can improve the clinical symptoms,enhance immune function,reduce micro inflammatory reaction,improve heart function and renal function,and has no obvious adverse effect on liver function.
基金项目
陕西省自然科学基础研究计划项目(2021JQ-787)
NETL
NSTL
万方数据