CAJ | 학술논문

目的：观察低分子肝素联合氯沙坦治疗糖尿病肾病（DN）的疗效。方法DN 患者70例分为氯沙坦组（30例）和低分子肝素组（40例），两组均给予糖尿病治疗方案及氯沙坦50 mg／d 口服，低分子肝素组加用低分子肝素6000 IU 皮下注射，1次／天，治疗的第2和第4周分别比较两组治疗前后的血压、24 h 尿蛋白定量（24 h－MTP）、血肌酐（Scr）、血脂、纤维蛋白原（FIB）、活化部分凝血活酶时间（APTT）等指标的变化，同时观察常见并发症发生情况。结果氯沙坦组治疗2、4周后血压明显改善，治疗4周后24 h－MTP 明显下降（P ＜0．05）。低分子肝素组治疗2、4周后24 h－MTP、Scr、FIB 下降，血压明显改善， APTT 延长（P ＜0．05），且24 h－MTP、Scr、FIB 均低于氯沙坦组，APTT 长于氯沙坦组（P ＜0．05）。两组无出血、低血压等并发症发生。结论低分子肝素联合氯沙坦可明显降低早期 DN 患者24 h 小时尿蛋白和改善肾功能，具有保护肾功能的作用，且安全性较好。
목적：관찰저분자간소연합록사탄치료당뇨병신병（DN）적료효。방법DN 환자70례분위록사탄조（30례）화저분자간소조（40례），량조균급여당뇨병치료방안급록사탄50 mg／d 구복，저분자간소조가용저분자간소6000 IU 피하주사，1차／천，치료적제2화제4주분별비교량조치료전후적혈압、24 h 뇨단백정량（24 h－MTP）、혈기항（Scr）、혈지、섬유단백원（FIB）、활화부분응혈활매시간（APTT）등지표적변화，동시관찰상견병발증발생정황。결과록사탄조치료2、4주후혈압명현개선，치료4주후24 h－MTP 명현하강（P ＜0．05）。저분자간소조치료2、4주후24 h－MTP、Scr、FIB 하강，혈압명현개선， APTT 연장（P ＜0．05），차24 h－MTP、Scr、FIB 균저우록사탄조，APTT 장우록사탄조（P ＜0．05）。량조무출혈、저혈압등병발증발생。결론저분자간소연합록사탄가명현강저조기 DN 환자24 h 소시뇨단백화개선신공능，구유보호신공능적작용，차안전성교호。
Objective To observe the effects of combination of losartan and low molecular weight heparin in the treatment of diabetic nephropathy(DN).Methods Seventy DN patients were divided into control group (n =30)and experimental group (n =40).The two groups were all given diabetic therapeutic regimen and losartan (50 mg/d).The experimental group was further given low molecular weight heparin (subcutaneous injection,1 time/d,and 6000U/d).The period of observation was 4 weeks.The levels of 24 h urine protein,serum creatinine (Cr),blood lipid,fibrinogen(FIB),activated partial thromboplastin time (APTT) and serum albumin (ALB)were compared at the time of 0,2 and 4 weeks after the treatments between the two groups .At the same time,the side-effects were also compared.Results In the control group,the levels of 24 h urine protein decreased significantly after 4 weeks of treatment when compared to the 0 week.In the experimental group,the levels of the 24 h urine protein and serum Cr began to decrease significant -ly after 2 weeks of therapy and this situation was more obvious after 4 weeks of therapy(P <0.05).The blood pressure of the two groups was improved dramatically during the 4 weeks of treatment(P <0.05).It is worth mentioning that 24 h urine protein,Scr and the value of FIB in the experimental group was lower than that in the control group (P <0.05)while the level of APTT in the experimen -tal group was greater than that in the control group (P <0.05).Referring to the complication,no bleeding and hypotension occurred . Conclusion The application of combination of low molecular weight heparin and losartan could significantly decrease the 24 h urine protein and improve the kidney function in the treatment of DN .