2型糖尿病合并肾病40例临床治疗分析doi：10.3969/j.issn.1007-614x.2014.16.21摘要目的：探讨2型糖尿病合并肾病临床治疗方法和疗效。方法：2013年2月-2014年2月收治2型糖尿病合并肾病患者40例，总结其临床特点，比较与非糖尿病肾病的区别。治疗时降糖药均选用普通胰岛素，每天餐前30分钟肌注。在此基础上，将患者分两组，分别加用毗格列酮和二甲双孤（治疗组）和单纯应用毗格列酮（对照组）治疗，治疗4个月，治疗前后分别测定24小时尿白蛋白排泄率、肾功等，比较疗效。结果：2型糖尿病合并肾病患者比非糖尿病肾病蛋白尿出现时间早，总胆固醇、甘油三酯值低，24小时尿蛋白定量和肾小球滤过率差异不明显。治疗后，两组FBG、HbAlc、LDL-C、Fib、UAER等降低明显，HDL-C、ISI水平提高，ALT、Cr无显著变化，说明治疗组肾保护功能强,与对照组比较，差异有统计学意义。结论：2型糖尿病合并肾病与非糖尿病肾病病理特点有明显不同，临床应自行鉴别。治疗时，毗格列酮和二甲双肌联合应用疗效显著，更适合临床应用。关键词2型糖尿病肾病临床治疗Analysisoftheclinicaltreatmentof40casesoftype2diabeticcombinedwithnephropathyXuShaofengTheThirdDepartmentofInternalMedicine,thePeople"sHospitalofFeixiCounty,Anhui231200AbstractObjective:Toexploretheclinicaltreatmentmethodsandcurativeeffectoftype2diabeticcombinedwithnephropathy.Methods：40caseswithtype2diabeticcombinedwithnephropathywereselectedfromFebruary2013toFebruary2014.Theclinicalcharacteristicsweresummaried,andcomparedwithnondiabeticnephropathy.Thehypoglycemicdrugsfortreatmentwereallinsulin.Itwasintramuscularinjected30minutesbeforemealseveryday.Onthisbasis,thecasesweredividedintotwogroups・Theyweretreatedwithpioglitazonecombinedwithmetformin(thetreatmentgroup)andthesimpleapplicationofpioglitazonetreatment(thecontrolgroup)・Theyweretreatedfor4months.24hoursurinaryalbuminexcretionrateandrenalfunctionwererespectivelymeasuredbeforeandafterthetreatment.Thecurativeeffectswerecompared・ResuIts:Theoccurrencetimeofproteinuriaofpatientswithtype2diabeticcombinedwithnephropathywasearlierthanthatofthenon-diabeticrenaldisease.Thetotalcholesterolandtriglyceridevalueswerelowerthanthoseofthenon-diabeticrenaldisease・Thedifferencesof24hoursurinaryproteinquantitativeandglomerularfiltrationratewerenotobvious.Afterthetreatment,FBG,HbAlc,LDL~C,Fib,UAERofthetwogroupsdecreasedsignificantly.HDL~C,ISIlevelwereincreased.ALT,Crhadnosignificantchange.Therenalprotectionfunctionofthetreatmentgroupwasstrong.Comparedwiththecontrolgroup,thedifferencehasstatisticalsignificance.Conelusion:Thepathologicalcharacteristicsbetweentype2diabeticcombinedwithnephropathyandnondiabeticnephropathyaresignificantlydifferent.Theyshouldselfidentificationinclinica1.Duringthetreatment,pioglitazonecombinedwithmetforminhasaobviouscurativeeffect.Itissuitableforclinicalapplication.KeywordsType2diabetic；Nephropathy；Clinicaltreatment2型糖尿病属于内分泌疾病，糖尿病肾病是发展到一定阶段常合并的并发症之一。据统计，2型糖尿病病程＞10年者，近50%并发糖尿病肾病［1］。合并肾病到终末期，会因肾功能衰竭导致死亡。糖尿病合并肾病的临床诊断与非糖尿病肾病相同，临床以蛋白尿为主要诊断指标。临床治疗多在胰岛素控制血糖基础上加用嗟P坐烷二酮类增敏剂，我院以毗格列酮和二甲双肌进行治疗，疗效显著，现报告如下。资料与方法2013年2月-2014年2月收治2型糖尿病合并肾病患者40例，女24例，男16例；年龄56〜76岁，平均年龄（67.3±1.3）岁；糖尿病病程9〜30年，平均病程（27.3±0.5）年；合并肾病病程0.3〜4年，平均病程（2.4±0.6）年。合并的肾病类型包括膜性肾病17例，肾小管间质肾病23例。将入选患者按投硬币方式随机分为治疗组和...