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目的:探讨骨化三醇联合盐酸吡格列酮对早期糖尿病肾病(DN)患者血脂、肾功能、炎症因子等指标的影响。方法:120例早期DN患者随机均分为对照组、V组、P组和V+P组。对照组患者给予糖尿病饮食、适度运动,重组甘精胰岛素注射液控制血糖等常规治疗;V组患者在对照组治疗的基础上给予骨化三醇胶丸0.25μg,口服,每日1次;P组患者在对照组治疗的基础上给予盐酸吡格列酮胶囊30 mg,口服,每日1次;V+P组患者在对照组治疗的基础上给予骨化三醇胶丸(用法用量同V组)+盐酸吡格列酮胶囊(用法用量同P组)。各组疗程均为3个月。观察各组患者治疗前后血脂[三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)]、肾功能[血肌酐(Scr)、血尿素氮(BUN)、尿白蛋白排泄率(UAER)]、炎症因子[C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6]水平及不良反应发生情况。结果:治疗前,各组患者血脂、肾功能、炎症因子水平比较,差异均无统计学意义(P>0.05)。治疗后,对照组患者TC、UAER,V组患者TC、LDL、IL-6、Scr、BUN、UAER,P组、V+P组患者TG、TC、LDL、Scr、BUN、UAER、CRP、TNF-α、IL-6均显著低于同组治疗前,V+P组患者TG、TC、LDL、Scr、BUN、UAER、CRP、TNF-α、IL-6及P组患者TG、Scr、CRP均显著低于对照组,而V+P组TG低于P组,差异均有统计学意义(P<0.05);各组患者HDL治疗前后比较,差异均无统计学意义(P>0.05)。各组患者治疗期间均未见明显不良反应发生。结论:在常规治疗的基础上,骨化三醇联合盐酸吡格列酮可显著降低早期DN患者血脂、改善肾功能及炎症状态,且安全性较好。
Objective: To investigate the effects of calcitriol combined with pioglitazone hydrochloride on blood lipid, renal function and inflammatory factors in patients with early diabetic nephropathy (DN). Methods: One hundred and twenty patients with early DN were randomly divided into control group, V group, P group and V + P group. Control group patients were given diabetes diet, moderate exercise, recombinant glargine injection to control blood sugar and other conventional treatment; V group patients in the control group based on the treatment given calcitriol 0.25μg, orally, once daily; P The patients in the control group were given pioglitazone hydrochloride capsules 30 mg orally once daily. The patients in the V + P group were given calcitriol capsules (the same dosage as the group V) + Pioglitazone capsules (Dosage with the same group P). Each course of treatment was 3 months. The levels of triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL) and low density lipoprotein (LDL), renal function [serum creatinine (Scr), blood urea nitrogen (BUN), urinary albumin excretion rate (UAER), inflammatory cytokines (CRP), tumor necrosis factor (TNF) -alpha and interleukin (IL) -6 and the incidence of adverse reactions. Results: Before treatment, there was no significant difference in the levels of blood lipids, renal function and inflammatory cytokines in each group (P> 0.05). After treatment, TG, TC, LDL, Scr, BUN, UAER, CRP, TNF in patients with TC, UAER and V in TC, LDL, IL-6, Scr, BUN, UAER, TC, LDL, Scr, BUN, UAER, CRP, TNF-α, IL-6 and P in patients with V + P before treatment were significantly lower than those before treatment (P <0.05). There was no significant difference between before and after HDL treatment in each group (P> 0.05). No significant adverse reactions occurred during the treatment of each group of patients. Conclusion: On the basis of routine treatment, calcitriol combined with pioglitazone hydrochloride can significantly reduce the blood lipids in early DN patients, improve renal function and inflammatory status, and have good safety.