目的 探討天芪降糖膠囊聯(lián)合氯沙坦治療早期糖尿病腎病的臨床效果。方法 選取2016年5月-2017年4月上海市浦東新區(qū)花木社區(qū)衛(wèi)生服務(wù)中心收治的早期糖尿病腎病患者72例，隨機(jī)分成對(duì)照組（36例）和治療組（36例）。對(duì)照組口服氯沙坦鉀片，100 mg/次，1次/d。治療組在對(duì)照組基礎(chǔ)上口服天芪降糖膠囊，1.6 g/次，3次/d。兩組均連續(xù)治療12周。觀察兩組患者臨床療效，比較治療前后兩組患者血清糖化血紅蛋白（HbA1c）、血肌酐（Scr）、24 h尿微量白蛋白（24 h UMA）、尿素氮（BUN）、中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白（NGAL）、足細(xì)胞標(biāo)志蛋白（PCX）、胰島素抵抗指數(shù)（HOMA-IR）、中性粒細(xì)胞/淋巴細(xì)胞比值（NLR）、腫瘤壞死因子（TNF）-α、IL-6、谷胱甘肽過氧化物酶（GSH-Px）和丙二醛（MDA）水平。結(jié)果 治療后，對(duì)照組和治療組臨床總有效率分別為72.2%和91.7%。兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者24 h UMA值、血清HbA1c、SCr、BUN、NGAL、PCX、HOMA-IR和外周血NLR水平均顯著降低（P<0.01）；且治療組比對(duì)照組更低（P<0.01）。治療后，兩組血清TNF-α、IL-6、MDA濃度較治療前均顯著減少，GSH-Px水平顯著升高，同組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組上述指標(biāo)顯著優(yōu)于對(duì)照組（P<0.05）。結(jié)論 應(yīng)用天芪降糖膠囊聯(lián)合氯沙坦治療早期糖尿病腎病可有效提高患者胰島素敏感性，減輕炎性損傷，調(diào)控氧化應(yīng)激狀態(tài)，保護(hù)腎臟功能。

Objective To investigate the clinical effect of Tianqi Jiangtang Capsules combined with losartan in treatment of early diabetic nephropathy. Methods Patients (72 cases) with early diabetic nephropathy in Huamu Community Health Service Center, Pudong New Area from May 2016 to April 2017 were randomly divided into control (36 cases) and treatment (36 cases). Patients in the control group were po administered with Losartan Potassium Tablets, 100 mg/time, once daily. Patients in the treatment group were po administered with Tianqi Jiangtang Capsules on the basis of the control group, 1.6 g/time, three times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, and the HbA1c, Scr, 24 h UMA, BUN, NGAL, PCX, HOMA-IR, NLR, TNF-α, IL-6, GSH-Px and MDA levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 72.2% and 91.7%, respectively, and there were differences between two groups (P < 0.05). After treatment, 24 h UMA, HbA1c, SCr, BUN, NGAL, PCX, HOMA-IR and NLR levels in two groups were significantly decreased (P < 0.01), and these indexes levels in the treatment group were significantly lower than those in the control group (P < 0.01). After treatment, TNF-α, IL-6 and MDA in two groups were significantly decreased, but GSH-Px was significantly increased, and the difference was statistically significant in the same group (P < 0.05), and these indexes levels in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Tianqi Jiangtang Capsules combined with losartan in treatment of early diabetic nephropathy can effectively improve insulin sensitivity, reduce inflammatory injury, regulate oxidative stress and protect renal function.

浦東新區(qū)衛(wèi)生系統(tǒng)優(yōu)秀青年醫(yī)學(xué)人才培養(yǎng)實(shí)施計(jì)劃項(xiàng)目