摘要
目的 观察羟苯磺酸钙联合沙格列汀对早期糖尿病肾病(DN)患者肾功能、血管内皮活性物质、足细胞损伤因子及炎症因子的影响.方法 前瞻性选取2021年4月至2022年9月就诊于长治市人民医院内分泌科的108例早期DN患者为对象,按照随机数字表法将其分为两组,每组各54例.对照组给予羟苯磺酸钙治疗,观察组给予羟苯磺酸钙+沙格列汀治疗.检测治疗前、治疗4周后两组肾功能[血肌酐、胱抑素-C、24 h尿蛋白(24 hUpro)、β2-微球蛋白(β2-MG)、尿素氮]、血管内皮活性物质[血管内皮生长因子(VEGF)、内皮素-1、血栓素B2(TXB2)、一氧化氮]、足细胞损伤指标(Podocin、Nephrin)及炎症因子[单核细胞趋化因子-1(MCP-1)、趋化因子配体9(CXCL9)、白细胞介素-18(IL-18)]差异,统计两组疗效.结果 治疗4周后,两组血肌酐、尿素氮、胱抑素-C、24 hUpro、β2-MG均较治疗前降低,且观察组的血肌酐、尿素氮、胱抑素-C、24 hUpro、β2-MG分别为(90.24±5.82)µmol/L、(5.07±0.76)mmol/L、(1.24±0.33)mg/L、(67.78±12.04)mg、(1.21±0.40)mg/L,均低于对照组[(94.25±6.23)μmol/L、(5.45±0.83)mmol/L、(1.77±0.36)mg/L、(76.23±14.47)mg、(1.82±0.44)mg/L],差异均有统计学意义(P＜0.05).治疗 4 周后,两组内皮素-1、TXB2、VEGF均较治疗前降低,一氧化氮治疗后较治疗前升高,且观察组的一氧化氮为(82.11±11.56)μmol/L,高于对照组[(74.25±9.86)μmol/L],内皮素-1、TXB2、VEGF 水平分别为(30.79±6.77)μg/L、(87.96±11.07)ng/L、(127.14±28.51)ng/mL,均低于对照组[(41.56±8.03)µg/L、(115.45±13.86)ng/L、(142.26±32.65)ng/mL],差异均有统计学意义(P＜0.05).治疗4周后,两组Podocin、Nephrin均较治疗前降低,且观察组的Podocin、Nephrin 水平分别为(0.74±0.19)、(1.31±0.74)ng/mL,均低于对照组[(1.23±0.21)、(1.92±0.96)ng/mL],差异均有统计学意义(P＜0.05).治疗4周后,两组MCP-1、IL-18、CXCL9水平均较治疗前降低,且观察组的MCP-1、IL-18、CXCL9 水平分别为(71.42±20.74)μg/mL、(124.12±22.50)ng/L、(2.04±0.58)ng/mL,均低于对照组[(98.63±43.77)μg/mL、(139.41±25.64)ng/L、(2.66±0.67)ng/mL],差异均有统计学意义(P＜0.05).观察组总有效率为90.74％,高于对照组(74.07％),差异有统计学意义(P＜0.05).结论 羟苯磺酸钙联合沙格列汀治疗早期DN可改善肾功能和血管内皮活性物质,减轻足细胞损伤,抑制炎症因子表达和氧化应激,提高疗效.
Abstract
Objective To observe the effects of calcium hydroxybenzenesulfonate combined with saxagliptin on serum renal function,vas-cular endothelial reactive substances,podocyte damage factor and inflammatory factor in patients with early diabetic nephropathy(DN).Methods A total of 108 patients with early DN who were admitted to the Department of Endocrinology,Changzhi People's Hospital from April 2021 to Sep-tember 2022 were prospectively selected as subjects.They were divided into two groups according to the random number table method,with 54 ca-ses in each group.The control group was given calcium hydroxybenzenesulphonate treatment,and the observation group was given calcium hydroxy-benzenesulphonate+saxagliptin treatment.Renal function[blood creatinine,cystatin-C,24 hUpro,β2-microglobulin(β2-MG),urea ni-trogen],vascular endothelial reactive substances[vascular endothelial growth factor(VEGF),endothelin-1,thromboxane B2(TXB2),nitric oxide],indicators of podocyte damage(Podocin,Nephrin)and inflammatory factors[monocyte chemokine-1(MCP-1),chemokine 9(CXCL9),interleukin-18(IL-18)]differences,and the efficacy of the two groups were counted.Results After 4 weeks of treatment,the serum creatinine,urea nitrogen,cystatin-C,24 hUpro and β2-MG in the two groups were lower than those before treatment,and the serum cre-atinine,urea nitrogen,cystatin-C,24 hUpro and β2-MG in the observation group were(90.24±5.82)μmol/L,(5.07±0.76)mmol/L,(1.24±0.33)mg/L,(67.78±12.04)mg and(1.21±0.40)mg/L,respectively,which were lower than those in the control group[(94.25±6.23)µmol/L,(5.45±0.83)mmol/L,(1.77±0.36)mg/L,(76.23±14.47)mg,(1.82±0.44)mg/L],the differences were statisti-cally significant(P＜0.05).The nitric oxide in the observation group was(82.11±11.56)μmol/L,which was higher than that in the control group[(74.25±9.86)µmol/L],the levels of endothelin-1,TXB2 and VEGF were(30.79±6.77)μg/L,(87.96±11.07)ng/L and(127.14±28.51)ng/mL,respectively,which were lower than those in the control group[(41.56±8.03)μg/L,(115.45±13.86)ng/L、(142.26±32.65)ng/mL],and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,Podocin and Nephrin in the two groups were lower than those before treatment,and the levels of Podocin and Nephrin in the observation group were(0.74±0.19)and(1.31±0.74)ng/mL,respectively,which were lower than those in the control group[(1.23±0.21),(1.92±0.96)ng/mL],the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the levels of MCP-1,IL-18 and CXCL9 in the two groups were lower than those before treatment,and the levels of MCP-1,IL-18 and CXCL9 in the observation group were(71.42±20.74)μg/mL,(124.12±22.50)ng/L and(2.04±0.58)ng/mL,respectively,which were lower than those in the control group[(98.63±43.77)μg/mL,(139.41±25.64)ng/L,(2.66±0.67)ng/mL],the differences were statistically significant(P＜0.05).The total effective rate of the observation group was 90.74％,which was higher than that of the control group(74.07％),and the difference was statistically significant(P＜0.05).Conclu-sion Calcium hydroxybenzenesulfonate combined with saxagliptin in the treatment of early DN improves renal function and vascular endothelial re-active substances,attenuates podocyte injury,inhibits the expression of inflammatory factors and oxidative stress,and improves efficacy.
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