【摘要】：目的探討抗幽門螺桿菌(Helicobacter pylori,H.pylori)治療對早期2型糖尿病腎病(diabetic kidney disease,DKD)臨床療效的影響。方法本研究選取我院2013年01月至2013年12月住院及門診治療的138例符合Mogensen DKD III期診斷的患者,采用14C尿素呼氣試驗(14C-urea breath test,14C-UBT)進行H.pylori感染檢測,經篩查其中H.pylori陽性者為80例。將此80例患者隨機分為抗H.pylori組(n=40)和非抗H.pylori組(n=40),兩組均進行糖尿病教育、指導合理運動、限制蛋白質飲食基礎上給予降糖及護腎治療3個月,保持血糖及血壓在一定范圍內,抗H.pylori組同時給予標準三聯(lián)療法,即口服蘭索拉唑(15 mg/次,2次/天),阿莫西林(1.0 g/次,2次/天),克拉霉素(0.5 g/次,2次/天)治療7天。對兩組治療3個月前后尿白蛋白肌酐比值水平(urinary albumin to creatine ratio,UACR)、C反應蛋白(C-reactive protein,CRP)、腫瘤壞死因子(tumor necrosis factor-α,TNF-α)、血漿內皮素(plasma endothelin-1,ET-1)、同型半胱氨酸(homocysteine,HCY)、甘油三酯(triglyceride,TG)、總膽固醇(total cholesterol,TC)數(shù)據(jù)進行記錄,并于治療3個月后復查14C-UBT,應用SPSS19.0軟件進行統(tǒng)計分析,計量資料以均數(shù)±標準差表示,兩組間計量資料比較采用獨立樣本t檢驗,組內治療前后比較采用配對t檢驗,計數(shù)資料比較采用χ2檢驗,P0.05為差異有統(tǒng)計學意義。結果1、經篩查80/138(57.97%)例Mogensen DKDⅢ期患者合并H.pylori感染;2、80例H.pylori感染患者中最終完成全部研究者共75例,包括抗H.pylori治療者39例及未抗H.pylori治療者36例,兩組患者在性別、年齡、糖尿病病程、體重指數(shù)(BMI)、治療前血糖(FBG、2h PG、Hb A1c)、血壓(SBP、DBP)、血脂(TG、TC)及血漿UACR、CRP、TNF-α、ET-1、HCY水平方面均無顯著統(tǒng)計學差異(P0.05)。3、治療3個月后抗H.pylori組的H.pylori清除率顯著高于未抗H.pylori組(56.41%vs5.6%,P0.01)。4、治療3個月后抗H.pylori組和未抗H.pylori組的血糖(FBG、2 h PG、Hb A1c)、血壓(SBP、DBP)及血脂(TG、TC)水平與治療前基線水平比較均無顯著統(tǒng)計學差異(P0.05)。5、兩組血漿UACR、CRP、TNF-α、ET-1、HCY水平均較治療前顯著下降(P0.01);抗H.pylori組治療后血漿UACR、CRP、TNF-α、ET-1、HCY水平均顯著低于未H.pylori組(P0.05)。結論抗H.pylori治療可能有助于降低DKD患者血漿UACR、CRP、TNF-α、ET-1、HCY水平,對延緩2型糖尿病早期腎病發(fā)展起一定作用。
[Abstract]:Objective to investigate the effect of anti-Helicobacter pylori (Helicobacter pylori,H.pylori) therapy on early type 2 diabetic nephropathy (diabetic kidney disease,DKD). Methods from January 2013 to December 2013, 138 inpatients and outpatients who met the stage of Mogensen DKD III diagnosis in our hospital were tested for H.pylori infection by 14C urea breath test (14C-urea breath test,14C-UBT). Among them, 80 cases were positive for H.pylori. The 80 patients were randomly divided into anti H.pylori group (n = 40) and non anti H.pylori group (n = 40). The two groups were given diabetes education to guide reasonable exercise, to treat hypoglycemia and protect kidney for 3 months on the basis of limiting protein diet, and to keep blood sugar and blood pressure within a certain range. The anti H.pylori group was treated with standard triple therapy: lansoprazole (15 mg/ day), amoxicillin (1. 0 g / d) and clarithromycin (0. 5 g / d twice a day) for 7 days. Serum levels of urinary albumin creatinine (urinary albumin to creatine ratio,UACR), tumor necrosis factor (tumor necrosis factor- 偽 (TNF- 偽), plasma endothelin (plasma endothelin-1,ET-1), homocysteine (homocysteine,HCY), triglyceride (triglyceride,TG) and total cholesterol (total cholesterol,TC) were recorded before and after 3 months of treatment in both groups. After 3 months of treatment, 14C-UBTs were reexamined and analyzed by SPSS19.0 software. The measurement data were expressed as mean 鹵standard deviation. The measurement data between the two groups were compared with independent sample t test, and matched t test was used before and after treatment. There was significant difference in counting data by 蠂 2 test (P 0.05). Results 1 after screening 80 / 138 (57.97%) Mogensen DKD stage 鈪，

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