来氟米特联合缬沙坦治疗早期糖尿病肾病的临床疗效及其对肾功能的影响

Clinical efficacy of Leflunomide combined Valsartan on early diabetic nephropathy and its impact on renal function

摘要:

摘要：目的  比较来氟米特（LEF）联合缬沙坦与其他常见的联合用药治疗早期糖尿病肾病（DN）患者的临床疗效。方法  选取2013年1月-2014年12月该院门诊与病房收治的DN患者189例，其中男性91例，女性98例。按随机数字表法将DN患者分为4组，其中缬沙坦组48例，仅用缬沙坦常规治疗；LEF组47例，使用缬沙坦联合LEF治疗；前列地尔组47例，使用缬沙坦联合前列地尔治疗；贝那普利组47例，使用缬沙坦联合贝那普利治疗。比较各组治疗前后的空腹血糖（FPG）、平均动脉压（MAP）、血肌酐（Scr）、尿素氮（BUN）、24 h尿蛋白定量（24 h Upro）及治疗有效率。结果  4组患者治疗总有效率比较，差异无统计学意义。4组患者的各项指标在治疗前比较，差异无统计学意义。治疗后，LEF组FPG水平最低，缬沙坦组与贝那普利组FPG、MAP、Scr、BUN、24 h Upro比较，差异有统计学意义；LEF组MAP、BUN水平最低，与其他组比较其下降值差异无统计学意义；LEF组24 h Upro最低，与缬沙坦组比较，差异有统计学意义；LEF组Scr水平低于缬沙坦组和前列地尔组，其下降值差异有统计学意义，LEF组Scr水平与贝那普利组比较，差异无统计学意义。结论  LEF联合缬沙坦治疗早期DN，相对于常见的缬沙坦联合前列地尔或贝那普利具有较好的整体疗效，不良反应少，值得临床推广。

Abstract:

Abstract： Objective To compare the clinical efficacy of the combination of Leflunomide (LEF) and Valsartan with other drug combinations in the treatment of early diabetic nephropathy (DN). Methods A total of 189 patients with DN were treated in our hospital from January 2013 to December 2014, including 91 males and 98 females. The DN patients were divided into 4 groups by random digital table method. Valsartan group (48 cases) accepted only conventional therapy with Valsartan; Leflunomide group (47 cases) was treated with Valsartan combined Leflunomide; Alprostadil group (47 cases) was treated with Alprostadil combined Valsartan; Benazepril group (47 cases) used Valsartan combined with Benazepril in the treatment. FPG, MAP, Scr, 24-h Upro, BUN and the treatment efficiency were compared among the groups before and after treatment. Results There were no significant differences in the indexes among the 4 groups before treatment. There were no significant differences in the total effective rate among the 4 groups. After treatment, the FPG level was the lowest in the Leflunomide group; there were significant differences in FPG, MAP, Scr, BUN and 24-h Upro levels between the Valsartan group and the Benazepril group; MAP and BUN levels were th lowest in the LEF group, the decreased values were not significantly different from those of other groups; the LEF group had the lowest 24-h Upro with significant difference from that of the Valsartan group; the SCR level of the LEF group was significantly lower than that of the Valsartan group and the Alprostadil group, but not significantly different from that of the Benazepril group. Conclusions The combination of Leflunomide and Valsartan has better overall efficacy in the treatment of early DN with fewer adverse reactions compared with other drug combinations. It is worthy of clinical promotion.