螺内酯对2型糖尿病肾病患者单核细胞趋化蛋白-1和Ⅳ型胶原的影响

Clinical significance of level changes of MCP-1 and CⅣ and therapeutic effects of spironolactone on inpatients with type Ⅱ diabetic nephropathy

目的探讨螺内酯对2型糖尿病肾病患者单核细胞趋化蛋白-1（MCP-1）和Ⅳ型胶原（CⅣ）水平的影响。方法2型糖尿病患者60例根据尿白蛋白排泄率（UAER）分为三组：正常尿白蛋白组、微量尿白蛋白组及临床尿白蛋白组，每组随机分为螺内酯治疗组和常规治疗组。分别采取治疗前和治疗12周后静脉血和24h尿。用ELISA法测定糖尿病患者血清CⅣ和尿MCP-1，以放射免疫法测定24h尿白蛋白含量。结果MCP-1和CⅣ在微量尿白蛋白组及临床尿白蛋白组中均明显高于健康对照组（P〈0．01或〈0．05）。螺内酯治疗组治疗12周后，三组患者MCP-1、CⅣ及UAER的降低差异均有统计学意义。结论CⅣ和MCP-1可能在糖尿病肾病中起重要作用，螺内酯治疗糖尿病肾病的机制可能是通过抑制核因子-κB（NF-κB）的表达实现的。

Objective To investigate the clinical significance of changes in the levels of MCP-1 and Ⅳ collagen（CⅣ ） after treatment with spironolactone on inpatients with diabetic nephropathy. Methods Sixty type 2 diabetic mellitus （T2DM） patients were divided into 3 groups randomly including the mass albuminuria group, the trace albuminuria group and normal albuminuria group according to urine albuminuria excretory rate（UAER）. Each group would be further divided into therapy group and control group.Venous blood samples and urine volume during 24 h were obtained in all patients before and after the administration of spironolactone for 12 weeks. The levels of MCP-1 and CⅣ were detected with ELISA,and the levels of total urinary proteins per 24 h were detected by radio-immunity. Results The levels of the MCP-1 and CⅣ in the mass albuminuria group and the trace albuminuria group were significantly higher than those in normal albuminuria group and healthy group（P 〈 0.05 or 〈 0.01 ）. After the administration of spironolactone the levels of the MCP-1, CⅣ and urinary proteins per 24 h decreased. Conclusions MCP-1 and CⅣ may play an important role in the pathogenesis of diabetic nephropathy. Spironolactone may achieve its therapeutic effects on diabetic nephrepathy by inhibiting the expression of NF- κB.