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目的:观察胰激肽原酶对糖尿病肾病(DN)临床期(Ⅳ期)患者肾功能及血流动力学的影响。方法:将145例DN处于Ⅳ期病例随机分为观察组(75例)和对照组(70例),对照组给予常规治疗,观察组在对照组治疗的基础上给予胰激肽原酶治疗。治疗8周后观察两组患者肾功能指标及血流动力学指标的变化。结果:治疗后,观察组血肌酐(SCr)、血尿素氮(BUN)、血胱抑素C(CysC)以及24 h尿白蛋白排泄率(UAER)水平均明显下降;对照组CysC和UAER明显下降,而SCr和BUN变化不明显,且观察组各指标均低于对照组,两组相比差异有统计学意义(t=4.2744,t=3.0832,t=6.8261,t=8.0936;P<0.05);治疗后两组收缩压(SBP)、舒张压(DBP)及阻力指数(RI)明显下降,肾动脉收缩期血流峰值速度(PSV)和舒张末期血流速度(EVD)明显上升,且观察组各指标变化幅度均大于对照组,差异有统计学意义(t=5.6270,t=6.2009,t=5.0926,t=4.764,t=3.1844;P<0.05)。结论:胰激肽原酶对DN处于Ⅳ期肾功能保护作用确切,能降低尿微量白蛋白排泄及改善血流动力学。
Objective: To observe the effect of pancreatic kininogenase on renal function and hemodynamics in patients with diabetic nephropathy (DN) during the clinical stage (Ⅳ). Methods: A total of 145 patients with DN in stage Ⅳ were randomly divided into observation group (n = 75) and control group (n = 70). The control group was given routine treatment. The observation group was treated with pancreatic kininogenase on the basis of the control group. After 8 weeks of treatment, the changes of renal function and hemodynamics were observed in both groups. Results: After treatment, the levels of serum creatinine (SCr), blood urea nitrogen (BUN), serum cystatin C (CysC) and urinary albumin excretion rate (UAER) in 24 hours were significantly decreased in the observation group, while CysC and UAER in the control group were significantly , While the changes of SCr and BUN were not obvious. The indexes of the observation group were lower than those of the control group (t = 4.2744, t = 3.0832, t = 6.8261, t = 8.0936; P <0.05 ); After treatment, systolic blood pressure (SBP), diastolic blood pressure (DBP) and resistance index (RI) decreased significantly in both groups, and PSV and EVD of systolic renal artery increased significantly The changes in each index in the observation group were greater than those in the control group, with significant differences (t = 5.6270, t = 6.2009, t = 5.0926, t = 4.764, t = 3.1844, P <0.05). CONCLUSION: Pancreatic kallikrein (DNase) has a definite protective effect on DN in renal function of stage Ⅳ, which can reduce urinary albumin excretion and improve hemodynamics.