依折麦布在膜性肾病中的临床应用

发布时间：2019-06-08 09:57

【摘要】：目的：本试验通过分别对试验组与对照组患者进行临床用药、观察并比较，两种不同治疗方案在膜性肾病合并血脂异常患者调脂治疗后的临床疗效、不良反应、及各项临床检测指标的变化差异，为膜性肾病合并血脂异常患者在临床调脂治疗方面，提供新思想、新策略，更好地进行临床调脂治疗和预防血脂异常并发症的发生。方法：研究对象为2012年1月至2013年12月期间，在延安大学附属医院住院的患者共60例，诊断均符合原发性肾病综合征，同时符合病理诊断均为膜性肾病，且治疗前4周均未接受过调脂治疗，肝功能及肾功能指标均正常。将研究对象随机分为两组：①试验组（30例），给予口服辛伐他汀10mg，1次/日，联合依折麦布10mg，1次/日；②对照组（30例），给予口服辛伐他汀20mg，1次/日。其余膜性肾病专科治疗均相同。于服药前、服药2周末、4周末、8周末时，分别检测患者血清各项血脂、转氨酶、肌酸激酶、24小时尿蛋白定量指标水平，随后观察并记录各组患者临床用药不良反应情况。采用SPSS16.0软件包处理数据，组间比较用两独立样本t检验，计数资料及两样本率比较用卡方检验。P 0.05有统计学差异。结果：①服药2周末、4周末时试验组与对照组患者，各项血脂指标水平比较，无统计学差异，转氨酶、肌酸激酶及24小时尿蛋白定量水平的变化比较，均无统计学差异(P0.05)。②服药8周末，试验组较对照组患者血清胆固醇水平有统计学差异（P0.05），余各项血脂指标及其他指标比较，，均无统计学差异(P0.05)。③服药8周末，试验组较对照组患者，不良反应发生率及调脂治疗有效率，无统计学差异(P0.05)。结论：①本试验中依折麦布联合辛伐他汀较单独应用辛伐他汀在原发性膜性肾病患者的临床调脂治疗中可以减少胆固醇的吸收，进一步降低血浆中的胆固醇水平，更好地做到血脂达标，避免血脂异常引起的并发症。②本试验中联合用药组较单独用药组并未增加肝功能异常的风险率，在消化道等不良反应发生率上无统计学差异，同时两组患者均无肌溶解等严重不良反应发生。
[Abstract]:Objective: to observe and compare the clinical efficacy and adverse reactions of the two different treatment schemes in patients with membranous nephropathy complicated with dyslipidemia after lipid regulation treatment, and to observe and compare the clinical efficacy and side effects of the two different treatments in patients with membranous nephropathy complicated with dyslipidemia. The changes of clinical detection indexes provided new ideas and strategies for patients with membranous nephropathy complicated with dyslipidemia in clinical lipid regulation treatment, so as to better carry out clinical lipid regulation treatment and prevent the occurrence of dyslipidemia complications. Methods: from January 2012 to December 2013, a total of 60 patients were hospitalized in the affiliated Hospital of Yan'an University. The diagnosis was in accordance with primary nephrotic syndrome and the pathological diagnosis was membranous nephropathy. No lipid regulating therapy was received 4 weeks before treatment, and the indexes of liver function and renal function were normal. The subjects were randomly divided into two groups: (1) the experimental group (n = 30) was given simvastatin 10 mg once a day, and the control group (30 cases) was given simvastatin 20 mg once a day. The other specialist treatments for membranous kidney disease were the same. Before taking medicine, at the end of 2nd, 4th and 8th week, the levels of serum lipid, transaminase, creatine kinase and 24-hour urinary protein were measured, and then the adverse reactions of clinical medication were observed and recorded. SPSS16.0 software package was used to process the data, two independent samples t test, counting data and chi-square test were used to compare the two sample rates. There was significant difference between the two groups. Results: 1 at the end of 2 weeks and 4 weeks, there was no significant difference in the levels of blood lipids between the experimental group and the control group, and the quantitative levels of transaminase, creatine kinase and 24-hour urinary protein were compared. There was no significant difference (P 0.05). 2 at the end of 8 weeks, the serum cholesterol level of the experimental group was significantly different from that of the control group (P 0.05), and the rest of the blood lipid indexes and other indexes were compared. There was no significant difference (P 0.05). 3 at the end of 8 weeks, the incidence of adverse reactions and the effective rate of lipid regulation in the experimental group were not significantly different from those in the control group (P 0.05). Conclusion: 1 in this study, etumab combined with simvastatin alone can reduce the absorption of cholesterol and further reduce the level of cholesterol in patients with primary membranous kidney disease in the clinical treatment of lipid regulation in patients with primary membranous kidney disease (PNS). The results show that simastatin alone can reduce the absorption of cholesterol and further decrease the level of cholesterol in plasma of patients with primary membranous nephropathy. In this experiment, the combined drug group did not increase the risk rate of abnormal liver function, and there was no significant difference in the incidence of adverse reactions such as digestive tract. At the same time, there were no serious adverse reactions such as myolysis in both groups.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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