目的 探討前列地爾聯(lián)合纈沙坦對(duì)糖尿病腎病（DN）患者氧化應(yīng)激水平、尿鈉排泄及血管內(nèi)皮活性的影響。方法 選取武漢市第一醫(yī)院門診與病房2021年11月—2022年10月期間收治的DN患者98例。根據(jù)治療方案不同，分為對(duì)照組（49例）和試驗(yàn)組（49例）。對(duì)照組給予纈沙坦治療，試驗(yàn)組給予前列地爾聯(lián)合纈沙坦治療，比較兩組治療前后氧化應(yīng)激指標(biāo)水平[晚期氧化蛋白產(chǎn)物（AOPP）、丙二醛（MDA）、超氧化物歧化酶（SOD）]，比較治療前后兩組腎功能情況[肌酐（Scr）、尿素氮（BUN）、24 h尿微量白蛋白定量（MALB）]；比較兩組治療前后24 h尿鈉及血漿腎素、醛固酮水平情況；比較治療前后兩組血管內(nèi)皮活性情況[血管內(nèi)皮生長(zhǎng)因子（VEGF）、一氧化氮（NO）、內(nèi)皮素-1（ET-1）]；觀察兩組臨床療效及不良反應(yīng)情況。結(jié)果 治療后，兩組AOPP、MDA降低，SOD水平上升，且試驗(yàn)組低于對(duì)照組（P＜0.05）；治療后，兩組肌酐Scr、BUN、MALB水平降低，試驗(yàn)組更明顯（P＜0.05）；治療后，兩組24 h尿鈉升高，腎素、醛固酮水平降低，且試驗(yàn)組更明顯（P＜0.05）；治療后，兩組VEGF、ET-1水平下降，NO水平升高，且試驗(yàn)組更明顯（P＜0.05），試驗(yàn)組療效優(yōu)于對(duì)照組（P＜0.05），兩組不良反應(yīng)無(wú)明顯差異（P＞0.05）。結(jié)論 前列地爾聯(lián)合纈沙坦治療DN的療效滿意，可有效降低患者氧化應(yīng)激水平，提高其尿鈉排泄，改善內(nèi)皮功能，且安全性較高，值得臨床推廣應(yīng)用。

Objective To investigate the effects of alprostadil combined with valsartan on oxidative stress, urinary sodium excretion and vascular endothelial activity in patients with diabetes nephropathy (DN). Methods A total of 98 DN patients admitted to outpatient and ward in Wuhan First Hospital from November 2021 to October 2022. According to different treatment schemes, they were divided into control group (49 cases) and experimental group (49 cases). The control group was treated with valsartan, and the experimental group was treated with alprostadil combined with valsartan. The levels of oxidative stress [advanced oxidation protein products (AOPP), malondialdehyde (MDA), superoxide dismutase (SOD)] before and after treatment were compared between the two groups, and the renal function [creatinine (Scr), urea nitrogen (BUN), 24-hour urine microalbumin (MALB)] before and after treatment were compared between the two groups. The levels of urinary sodium, plasma renin and aldosterone at 24 hours before and after treatment were compared between the two groups. The activity of vascular endothelial cells (VEGF, NO, ET-1) in the two groups were compared before and after treatment. The clinical efficacy and adverse reactions of the two groups were observed. Results After treatment, the levels of AOPP and MDA decreased and the levels of SOD increased in the two groups, and the experimental group was lower than the control group (P＜0.05). After treatment, the levels of creatinine Scr, BUN and MALB decreased in the two groups, which was more obvious in the experimental group (P＜0.05). After treatment, the urinary sodium increased and the levels of renin and aldosterone decreased in the two groups at 24 hours, which was more obvious in the experimental group (P＜0.05). After treatment, the levels of VEGF and ET-1 decreased and the levels of NO increased in the two groups, which were more obvious in the experimental group (P＜0.05). The curative effect of the experimental group was better than that of the control group (P＜0.05), and there was no significant difference in the adverse reactions between the two groups (P＞ 0.05). Conclusion The efficacy of alprostadil combined with valsartan in the treatment of diabetes nephropathy is satisfactory, which can reduce the level of oxidative stress in patients, increase their urinary sodium excretion, improve endothelial function, and has high safety, and is worthy of clinical application.

R977

湖北省衛(wèi)生健康委員會(huì)科研項(xiàng)目（WJ2018F038）