摘要目的 观察前列地尔注射液与贝前列素钠片序贯疗法对于老年临床糖尿病肾病(DN)期患者的临床疗效、安全性及影响. 方法 将老年临床期DN患者90例随机分为3组,对照组30例,常规治疗4周；前列地尔组30例,常规+前列地尔注射液治疗2周后,继续常规治疗2周；序贯治疗组30例,常规+前列地尔注射液治疗2周,常规+贝前列素钠片治疗2周.比较治疗前后24 h尿微量白蛋白(UMA)、总蛋白、肾血流、尿6酮-前列素F1α(6 keto-PGF1α)及血栓素B2的变化情况.结果 治疗4周后,前列地尔组和序贯治疗组UMA和总蛋白水平均较治疗前明显下降,两组UMA分别下降9.7％比25.6％,总蛋白分别下降16.0％比35.0％,序贯治疗组下降更明显(均P＜0.05).两组主肾动脉(MRA)阻力指数(RI)、段动脉(SRA) RI和叶间动脉(IRA) RI在治疗后均明显下降,序贯治疗组下降更明显(MRA RI:6.8％比8.2％,SRA RI:5.8％比9.7％,IRA RI:6.3％比9.1％),差异均有统计学意义(均P＜0.05).两组6-keto-PGF1α均上升,分别为(261.4±43.9)ng/24 h比(288.7±39.7)ng/24 h、(251.9±47.6)ng/24 h比(313.7±50.2)ng/24 h；两组尿血栓素B2均下降,分别为(172.4±33.5)ng/24 h比(152.1±31.6)ng/24 h、(177.3±28.8)ng/24 h比(130.6±34.7)ng/24 h,而序贯治疗组上述指标上升的改变更加明显(均P＜0.05).对照组治疗前后变化差异无统计学意义. 结论 前列地尔注射液与贝前列素钠片序贯疗法可能通过改善老年临床期DN患者肾血流以及血栓素A2和前列腺素I2的平衡,降低尿蛋白,且具有较好的安全性.

abstractsObjective To observe the curative effect and safety of the sequential therapy with alprostadil injection and beraprost sodium tablets in elderly type 2 diabetic patients on the stage of clinical diabetic nephropathy.Methods 90 elderly T2DM patients on clinical diabetic nephropathy stage were randomly divided into 3 groups:control group(conventional therapy for 4 weeks,n=30),alprostadil group(conventional therapy plus alprostadil injection for 2 weeks and conventional therapy for another 2 weeks,n =30) and sequential therapy group(conventional therapy plus alprostadil injection for 2 weeks and conventional therapy plus beraprost sodium tables for another 2 weeks,n=30).The levels of urine albumin(UMA),urine total protein(UTP),urine 6-ketoprostaglandin F1 alpha (6-keto-PGF1α) and urine thromboxane B2 (TXB2).were tested before and 4 weeks after corresponding therapies.Results In alprostadil group and sequential therapy group,the levels of UMA and UTP were significantly decreased 4 weeks after treatment as compared with pre-treatment [UMA:(453.9±90.2) mg/24 h vs.(404.7±60.3) mg/24 h,(465.9±85.4) mg/24 h vs.(340.1± 60.8) mg/24 h; UTP:(2.17±0.51) g/24 h vs.(1.72±0.47) g/24 h,(2.21±0.48) g/24 h vs.(1.44 ±0.39) g/24 h; respectively,all P＜0.01].The decreases in UMA and UTP levels were more obvious in sequential therapy group than in alprostadil group(UMA:25.6％ vs.9.7％ ; UTP:35.0％ vs.16.0％ ; both P＜0.05).The resistive index(RI) in major renal arteries(MRA),segmental renal arteries(SRA) and interlobar renal arteries(IRA) were significantly decreased in alprostadil group and sequential therapy group after treatment as compared with pre-treatment [MRA:(0.70 ± 0.04) vs.(0.75±0.05),(0.68±0.03) vs.(0.74±0.03); SRA:(0.66±0.04) vs.(0.70±0.04),(0.63± 0.03) vs.(0.70±0.04); IRA:(0.62±0.03) vs.(0.66±0.04),(0.60±0.04) vs.(0.66±0.04); respectively,all P＜0.01],and more obvious decreases in the RI in MRA,SRA and IRA were found in sequential therapy group than in alprostadil group(MRA:6.8％ vs.8.2％,SRA:5.8％ vs.9.7％,IRA:6.3％ vs.9.1％,all P＜0.05).Inalprostadil group and sequential therapy group,urine 6-keto-PGF1α level was increased from(261.4±43.9) ng/24 h to(288.7±39.7) ng/24 h and (251.9±47.6) ng/24 h to(313.7±50.2) ng/24 h,whereas urine TXB2was decreased from(172.4±33.5) ng/24 h to (152.1±31.6) ng/24 h,and from(177.3±28.8) ng/24 h to(130.6±34.7) ng/24 h respectively.The changes in urine 6-keto-PGF1α and TXB2 levels were more significant in sequential therapy group than in the alprostadil group (urine 6-keto-PGF1α:29.6％ vs.13.5％,urine TXB2:27.0％ vs.11.9％,both P＜0.05).No significant differences in these indicators were found in the control group before and after the treatment.Conclusions Sequential therapy with alprostadil injection and beraprost sodium tablets may effectively and securely reduce urinary albumin through regulating the renal hemodynamics and the balance of TXA2 and PGI2 in elderly type 2 diabetic patients on clinical diabetic nephropathy stage.