目的 探討達(dá)格列凈聯(lián)合阿托伐他汀治療糖尿病腎病的臨床效果。方法 前瞻性選取甘肅省武威市人民醫(yī)院2019年6月-2020年12月收治的87例糖尿病腎病患者為研究對(duì)象，應(yīng)用隨機(jī)數(shù)字分組法將患者分為對(duì)照組與試驗(yàn)組，對(duì)照組44例，試驗(yàn)組43例。在常規(guī)治療的基礎(chǔ)上，對(duì)照組患者口服達(dá)格列凈片，第1~3天，每天5 mg，第4天增加劑量，每次10 mg。試驗(yàn)組在對(duì)照組治療基礎(chǔ)上，同時(shí)患者口服阿托伐他汀片，每次20 mg，每天1次。兩組患者均進(jìn)行3個(gè)月治療，對(duì)比治療效果。分別于治療前后測(cè)定兩組患者尿白蛋白排泄率（UAER）、血清β2-微球蛋白（β2-MG）和胱抑素C （CysC）水平，應(yīng)用肌氨酸氧化酶法測(cè)定血肌酐水平；觀察并記錄兩組患者治療前后的餐后2 h血糖、空腹血糖和糖化血紅蛋白水平；觀察并記錄所有患者在治療中出現(xiàn)的不良反應(yīng)情況。結(jié)果 試驗(yàn)組治療總有效率93.02%，對(duì)照組總有效率81.81%，試驗(yàn)組總有效率顯著高于對(duì)照組（P<0.05）；治療前兩組患者UAER、β2-MG、CysC和血肌酐水平對(duì)比無(wú)明顯差異（P>0.05），治療后兩組患者UAER、β2-MG、CysC和血肌酐水平均顯著降低（P<0.05），且治療后試驗(yàn)組患者UAER、β2-MG、CysC和血肌酐水平低于對(duì)照組（P<0.05）；兩組患者治療前餐后2 h血糖、空腹血糖和糖化血紅蛋白水平對(duì)比無(wú)明顯差異（P>0.05），治療后兩組患者餐后2 h血糖、空腹血糖和糖化血紅蛋白水平均顯著降低（P<0.05），且治療后試驗(yàn)組患者的餐后2 h血糖、空腹血糖和糖化血紅蛋白水平顯著低于對(duì)照組（P<0.05）；對(duì)照組咳嗽1例、頭暈1例、惡心1例、頭痛2例，不良反應(yīng)發(fā)生率為11.36%，試驗(yàn)組咳嗽1例、頭暈2例、惡心1例、頭痛1例，不良反應(yīng)發(fā)生率為11.63%，兩組對(duì)比無(wú)明顯差異（P>0.05）。結(jié)論 糖尿病腎病患者在常規(guī)治療基礎(chǔ)上應(yīng)用阿托伐他汀聯(lián)合達(dá)格列凈進(jìn)行治療，患者的臨床癥狀明顯減輕，患者的腎功能得到改善，治療效果顯著提高；阿托伐他汀聯(lián)合達(dá)格列凈能減輕糖尿病腎病患者腎功能損傷和微血管并發(fā)癥，提升腎小球?yàn)V過(guò)功能，提高降糖效果，安全性好，值得臨床應(yīng)用推廣。

Objective To explore the clinical effect of atorvastatin combined with dagliquin in the treatment of diabetic nephropathy. Methods A total of 87 patients with diabetic nephropathy were selected from June 2019 to December 2020 in Wuwei People's Hospital of Gansu province. The patients were randomly divided into control group and experimental group, 44 cases in the control group and 43 cases in the experimental group. On the basis of routine treatment, patients in the control group were given Dagliquin Tablets orally, five mg per day on the first to third days, and ten mg per time on the fourth day. On the basis of the treatment of the control group, patients in the experimental group were given oral Atorvastatin Tablets, 20 mg each time, once a day. Patients in two groups were treated for three months, and the therapeutic effects were compared. Urinary albumin excretion rate (UAER), serum β2-microglobulin (β2-MG) and cystatin C (CysC) were measured before and after treatment, and serum creatinine was measured by sarcosine oxidase method. The levels of postprandial blood glucose, fasting blood glucose and glycosylated hemoglobin were observed and recorded before and after treatment. The adverse reactions of all patients during treatment were observed and recorded. Results In the experimental group, the total effective rate was 93.02%. In the control group, the total effective rate was 81.81%. Thetotal effective rate in the experimental group was significantly higher than that in the control group (P < 0.05). Before treatment, there was no significant difference in the levels of UAER, β2-MG, CysC and blood creatinine between the two groups (P>0.05). After treatment, the levels of UAER, β2-MG, CysC and serum creatinine in the two groups decreased significantly (P < 0.05), and the levels of β2-MG, CysC and serum creatinine in the experimental group were lower than those in the control group (P < 0.05). There was no significant difference in the levels of postprandial blood glucose, fasting blood glucose and glycosylated hemoglobin between the two groups before treatment (P>0.05). The levels of postprandial blood glucose, fasting blood glucose and glycosylated hemoglobin in the two groups decreased significantly after treatment (P < 0.05). The levels of fasting blood glucose and glycosylated hemoglobin in the experimental group were significantly lower than those in the control group (P < 0.05). There were one case of cough, one case of dizziness, one case of nausea and two cases of headache in the control group, and the adverse reaction rate was 11.36%. There were one case of cough, two cases of dizziness, one case of nausea and one case of headache in the experimental group. The incidence of adverse reactions was 11.63%. There was no significant difference between the two groups (P>0.05). Conclusion Diabetic nephropathy patients treated with atorvastatin combined with dagliquin on the basis of conventional treatment, the clinical symptoms of patients were significantly reduced, the renal function of patients was improved, and the treatment effect was significantly improved. The combination of atorvastatin and dagliquin can reduce the renal damage and microvascular complications in diabetic nephropathy patients, improve glomerular filtration function, improve the effect of lowering blood sugar, and have good safety. It is worthy of clinical application and promotion.

R969.4

武威市市列科技計(jì)劃項(xiàng)目（WW1902023）