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目的:观察不同剂量辛伐他汀对老年早期糖尿病肾病患者炎症因子和肾功能的影响。方法:160例老年早期糖尿病肾病患者随机分为对照组、低剂量组、常规剂量组和大量组。各组均给予基础治疗,低剂量组、常规剂量组、大量组分别在基础治疗同时加用辛伐他汀10,20,40 mg·d-1。4周后观察比较各组患者治疗前后炎症因子(CRP、ICAM-1、IL-1β)和肾功能指标(BUN、Cr、UAER、24h Upro、Uβ2-MG)变化及药品不良反应。结果:治疗后大量组CRP水平较治疗前显著降低,且明显低于对照组治疗后(P<0.05);治疗后低量组、常量组和大量组ICAM-1水平均较治疗前显著降低,且明显低于对照组治疗后(P<0.05);治疗后4组IL-1β水平均无明显变化(P>0.05)。治疗后4组BUN水平均无明显变化(P>0.05);Cr、UAER水平均较治疗前显著降低(P<0.05),且辛伐他汀各剂量组均低于对照组治疗后(P<0.05),常量组和大量组低于低量组(P<0.05);治疗后辛伐他汀各剂量组24 h Upro、Uβ2-MG水平均较治疗前显著降低,且低于对照组治疗后(P<0.05);且常量组和大量组Uβ2-MG水平低于低量组治疗后(P<0.05),大量组低于常量组治疗后(P<0.05)。四组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:辛伐他汀治疗从炎症因子和肾功能指标两个方面可以改善糖尿病肾病的病情,大剂量辛伐他汀表现出一定的优势。
Objective: To observe the effects of different doses of simvastatin on inflammatory factors and renal function in elderly patients with early diabetic nephropathy. Methods: 160 elderly patients with early diabetic nephropathy were randomly divided into control group, low dose group, conventional dose group and a large number of groups. Each group were given basic treatment, low-dose group, conventional dose group, a large number of groups were treated with simvastatin 10,20,40 mg · d-1.4 for the first week after treatment, compared with the control group before and after treatment of inflammatory cytokines (CRP, ICAM-1, IL-1β) and renal function parameters (BUN, Cr, UAER, 24h Upro, Uβ2-MG) and adverse drug reactions. Results: The levels of CRP in a large number of groups after treatment were significantly lower than those before treatment (P <0.05), and the levels of ICAM-1 in low dose group, high dose group and large dose group were significantly lower than those before treatment (P <0.05). There was no significant change in IL-1β level in the four groups after treatment (P> 0.05). The levels of BUN and UAER in four groups were significantly lower than those before treatment (P <0.05), and the levels of BUN in simvastatin group were lower than those in the control group after treatment (P <0.05) (P <0.05). After treatment, the levels of Upro and Uβ2-MG at 24 h in each dose of simvastatin were significantly lower than those before treatment (P <0.05), and were lower than those in the control group after treatment <0.05). The level of Uβ2-MG in the constant group and the large number of groups was lower than that in the low group (P <0.05), and the levels of Uβ2-MG in the large group were lower than those in the constant group (P <0.05). The incidence of adverse reactions in the four groups, the difference was not statistically significant (P> 0.05). Conclusion: Simvastatin can improve the condition of diabetic nephropathy in both aspects of inflammatory factor and renal function, and high dose of simvastatin shows some advantages.