法舒地尔对2型糖尿病早期肾病患者尿Smad1和白蛋白的影响-内科学专业论文.docx

目 录 中文摘要 ·············································································· 1 英文摘要 ·············································································· 4 英文缩写……………………………………………………………………..8 研究论文 法舒地尔对 2 型糖尿病早期肾病患者尿 Smad1 和白蛋白的影 响 前言 ·············································································· 9 材料与方法 ····································································11 结果 ·············································································17 附图 ·············································································19 附表 ·············································································22 讨论 ·············································································26 结论 ·············································································29 参考文献 ·······································································30 综述 RhoA/ROCK 信号通路在糖尿病肾病中的作用 ·····················34 致谢 ···················································································47 个人简历 ·············································································48 法舒地尔对 2 型糖尿病早期肾病患者尿 Smad1 和白蛋白的影响 摘 要 目的：糖尿病肾病是糖尿病最常见最严重的微血管并发症，也是糖 尿病患者重要的死亡原因之一。糖尿病肾病的发病机制较为复杂，目前临 床上还没有特别有效的措施能够阻止其发生和进展。本研究的目的是通过 观察法舒地尔对 2 型糖尿病早期肾病患者血和尿中 Smad1 水平以及尿白 蛋白的影响，探讨法舒地尔对 2 型糖尿病患者早期肾病的肾脏保护作用及 可能机制，以期为糖尿病肾病的防治提供新的思路。 方法：选取我院内分泌科 2015 年 1 月至 2015 年 12 月住院的 2 型糖 尿病早期肾病患者 62 例作为微量白蛋白尿组，选取门诊无急、慢性并发 症的 2 型糖尿病患者 20 例作为单纯糖尿病组，选取我院健康志愿者 20 例作为正常对照组。对入选的糖尿病患者均给予糖尿病教育及管理，严格 控制血糖，使入选的糖尿病患者血糖控制到理想水平。分别测定三组中的 空腹血糖（FBG）、糖化血红蛋白（HbA1c）；总胆固醇（TC）、甘油 三酯（TG）；尿素（BUN）、肌酐（Cr）；谷丙转氨酶（ALT）、谷草 转氨酶（AST）；尿微量白蛋白（MALB）、尿白蛋白与肌酐比值（ACR）； 并采用双抗体夹心 ABC-ELISA 法测定三组的血和尿的 Smad1 水平，将三 组的指标进行统计分析。将微量白蛋白尿组患者随机分为前列地尔组（30 例）和法舒地尔治疗组（32 例）。前列地尔组在常规治疗的基础上加用 前列地尔 10 μg 入壶，1 次/d，治疗 14 天。法舒地尔组给予盐酸法舒地尔 30mg 加入生理盐水 100 ml 静脉滴注，2 次/d，治疗 14 天。分别检测两组 治疗前后上述指标以及血小板聚集率（PAgR），并进行组间和组内比较。 结果： 1 基线时三组间的比较 1.1 血糖、血脂、肾功能和肝功能指标：与正常对照组比较，单纯糖尿病 组与微量白蛋白尿组的 FBG、HbA1c、TC、TG 显著升高（P0.01）；但 单