摘要目的 探讨糖尿病肾病患者心血管事件的预测指标和防治措施。方法 选择58例糖尿病肾病患者，按照病历单双号分为常规治疗组（33例）和银杏叶治疗组（30例）。常规治疗组采用常规治疗，银杏叶治疗组在常规治疗基础上加用银杏叶胶囊口服治疗。所有患者治疗前检测血压、血脂等常规生化指标，并在治疗前、治疗后每3个月检测1次脑钠肽(BNP)和心脏彩超。观测终点为患者死亡或发生心血管事件。结果 两组患者入选时年龄、性别构成、血压、血脂、血肌酐、血红蛋白、BNP、左室舒张早期与晚期最大血流比(E/A)和左室射血分数(LVEF)比较差异无统计学意义(P＞0.05)。治疗后12个月银杏叶治疗组血浆BNP较常规治疗组明显下降，并一直保持显著低于常规治疗组水平(P＜0.01)；分别于治疗后18个月和24个月心脏彩超显示左室E/A和LVEF优于常规治疗组（P＜0.01或＜0.05）；治疗后12个月血浆BNP与治疗后24个月左室E/A和LVEF均呈显著相关性（r值分别为0.61和-0.68,P＜0.05）；生存分析表明，治疗后6个月血浆BNP升高的患者随访期内心血管事件发生概率也明显升高(P=0.03)；Cox分析表明，该时间点血浆BNP明显升高是糖尿病肾病患者心血管事件的独立预测因子。结论 BNP水平对糖尿病肾病患者心血管事件有预测价值，银杏叶胶囊能降低糖尿病肾病患者BNP水平并降低心血管事件的发生概率。

abstractsObjective To investigate the predictor and prophylaxis of cardiovascular events in diabetic nephropathy (DN) patients. Methods Fifty-eight cases of DN patients were assigned randomizedly to two groups. Conventional treatment group (33 cases) received conventional treatment, and ginkgo biloba extract group (30 cases) received extra ginkgo biloba extract capsules treatment. Plasma examination for blood fat, blood pressure(Bp), brain natriuretic peptide(BNP) and echocardiogram was performed every 3 months. All the patients were followed-up for the occurrence of cardiovascular events. Results There were no significant differences in age, sex, Bp, blood fat, serum creatinine, hemoglobin,BNP, left ventricular E/A and left ventricular ejection fraction (LVEF) in two groups at the time of recruitment. After treatment of 12 months, the level of plasma BNP decreased significantly in ginkgo biloba extract group and maintained in the lower levels throughout the follow-up compared with that in conventional treatment group(P＜ 0.01 ). After treatment of 18 and 24 months, left ventricular E/A and LVEF were better in ginkgo biloba extract group than those in conventional treatment group(P ＜ 0.01 or ＜ 0.05 ). In ginkgo biloba extract group, the level of plasma BNP after treatment of 12 months had correlation with left ventricular E/A and LVEF after treatment of 24 months (r =0.61, -0.68, P ＜ 0.05 ). Survival analysis indicated that the level of plasma BNP was a predictor of cardiovascular event in DN patients. Conclusion The level of plasma BNP can be used as a predictor of cardiovascular event in DN patients,and ginkgo biloba extract capsules can decrease the level of plasma BNP and reduce the incidence of cardiovascular events in DN patients.