实验研究(医学)(1).docVIP

不同降血糖方法对早期糖尿病肾病进程影响 作者：贺海东1，余　晨2 作者单位：(1.同济大学在读研究生， 2.上海东方医院肾内科，上海　201100) 【摘要】目的：比较不同降血糖方法治疗早期糖尿病肾病患者的疗效，探讨该期患者应用胰岛素治疗对于病程进展的预防及治疗作用。方法：选取128例糖尿病肾病患者，入选时肾小球滤过率处于CKD1～3期，分为A、B两组，分别给予胰岛素治疗(包括胰岛素强化治疗、常规胰岛素治疗、胰岛素联合口服降糖药治疗)、非胰岛素治疗(口服降糖药治疗)，对治疗结果进行分析比较，评判不同降血糖方法的疗效及影响因素。结果：128例糖尿病肾病患者经不同方法治疗后，总有效97例(75.8%)，无效31例(24.2%);A组总有效52例(86.7%)，B组总有效45例(66.2%)，A、B两组总有效率差异有统计学意义(P0.05)。治疗疗效与患者糖尿病病程、肾功能分期、年龄、血压、血脂相关(r分别为0.257、0.362、0.380、0.249、0.276，P均0.05)，与患者烟酒嗜好、性别情况无明显相关(r分别为1.242、1.516，P0.05)。结论：应用胰岛素控制血糖能够有效减缓肾脏病变进展速度，是预防及治疗糖尿病肾病的有效方法。 【关键词】 糖尿病肾病; 胰岛素;病程进展 [ABSTRACT] Objective： To compare the efficacy of different hypoglycemic treatments on early diabetic nephropathy， and to evaluate the preventive and therapeutic effect of insulin. Methods： A total of 128 patients with diabetic nephropathy with glomerular filtration rate (GFR) at CKD1- 3 phase were divided into two groups. Patients in Group A (n=60) were treated by insulin therapy (including intensified insulin therapy， conventional insulin therapy， combined therapy of insulin therapy and oral hypoglycemic drug treatment). While patients in Group B(n=68) were given non-insulin treatment (oral hypoglycemic drug treatment). The hypoglycemic efficacy was cmpared and impact factors were analyzed. Results：A total of 97 cases were effective (75.8%)， 31 cases were ineffective (24.2%)， including 52 effective cases in Group A (86.7%) and 45 effective cases in Group B (66.2%). There was significant difference in total efficacy between two groups (P0.05). The efficacy was related with course of diabetes， stage of renal function， age， blood pressure and blood lipid (r=0.257,0.362,0.380,0.249,0.276，respectively， and all P0.05)， but not related with tobacco and alcohol habits and sex(r=1.242，and 1.516，respectively， P0.05). Conclusions： Insulin can effectively slow down the progress of kidney disease. It is effective on prevention and treatment of diabetic nephropathy. [KEY WORDS] Diabetic nephropathy; Insulin; Dise