循环内皮细胞水平与糖尿病肾病的相关性及银杏达莫的干预作用

Plasma level of circulating endothelial cells in patients with early diabetic nephropathy and interventional treatment of ginkgo-damole injection

目的：探讨外周血循环内皮细胞（CEC）和糖尿病肾病（DN）的相关性，以及银杏达莫注射液在DN防治中的可能作用。方法：检测65例2型糖尿病患者24h尿白蛋白排泄率（UAER）及CEC数，分析两者的相关性。将UAER为30—300mg·d^-1的45例患者随机分为两组，常规治疗组22例，进行常规降血糖、控制血压等治疗；银杏达莫治疗组23例，在常规治疗基础上静脉滴注银杏达莫注射液2周。比较两组治疗前后血糖、血压、UAER及CEC水平的变化。结果：单纯糖尿病（SDM）组和早期糖尿病肾病（Ⅱ）N）组的外周血CEC水平比对照组（NC）显著性升高，并呈逐渐增高的趋势（P〈0．01）。UAER与收缩压（SBP）、外周血CEC水平呈正相关（P〈0．01）。EDN组中，银杏达莫治疗后UAER及CEC明显降低（P〈0．01）；而常规治疗组无明显变化。线性多元逐步回归分析表明，银杏达莫治疗后UAER的改变与CEC数的变化成正相关（P〈0．01）。结论：血管内皮细胞（VEC）损伤在DN发生发展中起重要作用，银杏达莫对VEC的保护作用可能是其延缓DN发展的重要机制。

AIM： This study was undertaken to explore the relationship between urinary albumin excretion rate （UAER） and plasma level of circulating endothelial cells （CEC）in patients with early diabetic nephropathy （EDN） and the interventional role of ginkgo-damole injection （GDI） on development of UAER in patients with EDN. METHODS： UAER and plasma level of CEC were measured in 65 cases with type 2 diabetes mellitus, and the relationship between them was analyzed. 45 cases with diabetic nephropathy whose value of UAER is 30 - 300 mg·d^-1 were randomly divided into two groups. The 22 patients in the control group were treated by routine method including decreasing blood sugar and controlling blood pressure. The 23 patients in the treated group were treated with GDI 20 ml per day by intravenous dripping, with 2 weeks as one therapeutic course. The blood sugar, blood pressure, UAER and CEC in the two groups were observed and compared. RESULTS： Plasma level of CEC was markedly elevated in patients without albuminuria （SDM group） and patients with trace albtuninuria （EDN group） when compared to the group of normal controis （NC group） （ P 〈 0.01 ）, and plasma level of CEC in EDN group was significantly higher than that in SDM （P 〈 0.01 ）. There was significant positive correlation between UAER and systolic blood pressure （SBP） as well as CEC level （P 〈 0.01 ）. After treatment with GDI, UAER and CEC level were obviously decreased in EDN group （P 〈 0.01 ）. There was significant positive correlation between change of UAER and that of CEC level （P 〈 0.001）. However, those in the control group were little changed. CONCLUSION： VEC injury may play an important role in the pathogenesis of diabetic nephropathy. GDI has protective function on early diabetic nephropathy by preventing VEC from being damaged.