雙重腎素-血管緊張素系統(tǒng)阻斷治療1~3a期糖尿病腎病的效果分析

陳麗萍

【摘要】 目的：探討雙重腎素-血管緊張素系統(tǒng)（RAS）阻斷在1～3a期糖尿病腎病中的應(yīng)用效果。方法：選取2019年1月-2022年1月武威市中醫(yī)醫(yī)院收治的86例1～3a期糖尿病腎病患者，使用隨機(jī)數(shù)字表法將其分為觀察組（n=43）及對(duì)照組（n=43）。對(duì)照組接受單重緊張素系統(tǒng)阻斷[血管緊張素Ⅱ受體拮抗劑（ARB）]治療，觀察組接受雙重RAS阻斷治療[血管緊張素轉(zhuǎn)換酶抑制（ACEI）聯(lián)合ARB]治療。比較兩組腎功能指標(biāo)、糖代謝指標(biāo)、炎癥因子指標(biāo)及多聚ADP核糖聚合酶（PARP）與3-磷酸甘油脫氫酶（GAPDH）活性。結(jié)果：治療前，兩組尿素氮（BUN）、血肌酐（Scr）及腎小球?yàn)V過(guò)率（eGFR）水平比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；治療后，兩組BUN及Scr水平均較治療前降低，觀察組均低于對(duì)照組；eGFR均較治療前升高，觀察組高于對(duì)照組（P<0.05）。治療前，兩組空腹血糖（FPG）、餐后2 h血糖（2 h PG）、糖化血紅蛋白（HbA1c）、空腹胰島素（FINS）、胰島素抵抗指數(shù)（HOMA-IR）、單核細(xì)胞趨化蛋白-1（MCP-1）、轉(zhuǎn)化生長(zhǎng)因子-β1（TGF-β1）及腫瘤壞死因子-α（TNF-α）水平比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；治療后，兩組FPG、2 h PG、HbA1c、FINS、HOMA-IR、MCP-1、TGF-β1、TNF-α均較治療前降低，觀察組均低于對(duì)照組（P<0.05）。治療前，兩組PARP與GAPDH比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；治療后，兩組的PARP均較治療前降低，觀察組低于對(duì)照組；GAPDH均較治療前上升，觀察組高于對(duì)照組（P<0.05）。結(jié)論：雙重RAS阻斷可改善1～3a期糖尿病腎病患者的腎功能、減輕炎癥反應(yīng)，調(diào)節(jié)PARP與GAPDH活性，改善糖代謝，效果優(yōu)異。

【關(guān)鍵詞】 糖尿病腎病 腎素-血管緊張素系統(tǒng) 血管緊張素轉(zhuǎn)換酶抑制 血管緊張素受體Ⅱ拮抗劑

[Abstract] Objective： To investigate the effect of dual renin-angiotensin system （RAS） blockade in the treatment of stage 1-3a diabetic nephropathy. Method： A total of 86 patients with stage 1-3a diabetic nephropathy admitted to Wuwei Hospital of Traditional Chinese Medicine from January 2019 to January 2022 were selected， they were divided into observation group （n=43） and control group （n=43） according to the random number table method. The control group received single angiotensin system blockade [angiotensin receptor Ⅱ antagonist （ARB）] and the observation group received dual RAS blockade [angiotensin-converting enzyme inhibition （ACEI） combined with ARB]. The renal function indexes， glucose metabolism indexes， inflammatory factor indexes and poly ADP ribose polymerase （PARP） and 3-phosphoglycerol dehydrogenase （GAPDH） activities of the two groups were compared. Result： Before treatment， there were no significant differences in the levels of blood urea nitrogen （BUN）， blood creatinine （Scr） and glomerular filtration rate （eGFR） between the two groups （P>0.05）; after treatment， the levels of BUN and Scr in both groups were lower than those before treatment， those in the observation group were lower than those in the control group; eGFR were higher than those before treatment， that in the observation group was higher than that in the control group （P<0.05）. Before treatment， there were no significant differences in fasting plasma glucose （FPG）， 2 h postprandial glucose （2 h PG）， glycated hemoglobin （HbA1c）， fasting insulin （FINS）， insulin resistance index （HOMA-IR）， monocyte chemotactic protein-1 （MCP-1）， transforming growth factor-β1 （TGF-β1） and tumor necrosis factor-α （TNF-α） levels between the two groups （P>0.05）; after treatment， FPG，

2 h PG， HbA1c， FINS， HOMA-IR， MCP-1， TGF-β1 and TNF-α in both groups were reduced compared with those before treatment， those in observation group were lower than those in control group （P<0.05）. Before treatment， there were no significant differences in PARP and GAPDH between the two groups （P>0.05）; after treatment， PARP in both groups were lower than those before treatment， that in observation group was lower than that in control group， GAPDH in both groups were higher than those before treatment， that in observation group was higher than that in control group （P<0.05）. Conclusion： Dual RAS blockade can improve renal function， reduce inflammatory response， regulate PARP and GAPDH activities， and improve glucose metabolism in diabetic nephropathy patients with chronic kidney disease stage 1-3a with excellent effects.

[Key words] Diabetic nephropathy Renin-angiotensin system Angiotensin-converting enzyme inhibition Angiotensin receptor Ⅱ antagonist

First-author's address： Wuwei Hospital of Traditional Chinese Medicine， Gansu Province， Wuwei 733000， China

doi：10.3969/j.issn.1674-4985.2023.15.006

糖尿病腎病是多種因素作用于機(jī)體導(dǎo)致的胰島功能衰退、胰島素抵抗等引發(fā)的糖、蛋白質(zhì)等一系列代謝紊亂綜合征，是糖尿病中嚴(yán)重和危險(xiǎn)的微血管并發(fā)癥之一，已逐漸成為終末期腎病的最主要原因[1-2]。目前臨床治療糖尿病腎病的基礎(chǔ)策略為腎素-血管緊張素系統(tǒng)（RAS）阻斷。但目前臨床對(duì)于RAS阻斷方案用法爭(zhēng)議較大，部分醫(yī)師提倡使用優(yōu)化劑量的單藥阻斷，部分醫(yī)師更傾向于雙重RAS阻斷[3]。因此對(duì)于RAS阻斷方案進(jìn)行探究意義重大。同時(shí)……