肾康丸与阿托伐他汀对早期糖尿病肾病患者炎症因子影响的比较

To Compare Effects of Shenkangwan or Atorvastatin on Serum inflammatory cytokines in Type 2 Diabetic Patients with early Diabetic Nephropathy

目的比较肾康丸与阿托伐他汀对早期糖尿病肾病(DN)炎症细胞因子的影响,探讨其肾脏保护作用。方法将符合标准的88例DN患者随机分为对照组(C组)、阿托伐他汀治疗组(DA组)和肾康丸治疗组(DS组)。在有效控制血糖的基础上DA组和DS组分别以阿托伐他汀和肾康丸治疗8周。治疗前后分别观察各组患者空腹血糖(FBG),血清胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),尿α1-微球蛋白(α1-MG),血清急性时相反应蛋白C(CRP)、白介素6(IL-6)、肿瘤坏死因子-α(TNF-α)。FBG、血脂测定采用自动生化仪测定,α1-MG用放射免疫分析法(RIA)、CRP用散射免疫比浊法(PENIA)法测定,IL-6、TNF-α采用酶联免疫吸附试验(ELISA)测定。结果治疗后DS组FBG与C组和DA组比,明显降低,差异有显著性(P<0.05)。治疗后DA组TC、TG、LDL-C均明显下降,HDL-C明显升高,与治疗前比差异有显著性(P<0.01);C组和DS组上述指标与治疗前比差异无显著性(P>0.05)。治疗后DA组、DS组尿α1-MG,血CRP、IL-6、TNF-α分别较治疗前明显下降,差异有显著性(P<0.01),与C组比亦差异有显著性(P<0.01);治疗后DS组上述各指标较DA组下降更明显,二者相比差异有显著性(P<0.05,P<0.01)。C组各指标与本组治疗前比差异无明显性(P>0.05)。结论肾康丸和阿托伐他汀均可降低DN患者尿α1-MG及血炎症细胞因子水平,具有不依赖于降糖、降脂的肾脏保护作用,前者作用更明显。

Objective To compare effects of Shenkangwan or Atorvastatin on inflammatory cytokines in type 2 diabetic patients with early diabetic nephropathy（ DN）, and explore its therapeutic mechanism. Methods 88 cases of DN were randomly divided into the control group （C,n = 28） ,the Atorvastatin treated group （DA,n = 30） and the Shenkangwan treated group （DS,n = 30）. Education course, dietary treatment and conventional hypoglycemic agent were given to three groups, Atorvastatin and Shenkangwan was given additionally to patients in the DA and DS groups respectively. Fasting blood glucose （FBG）, Lipids（compose of TC, TG, LDL - C and HDL - C）, urine α1 - MG, C - reactive protein （CRP） , interleukin - 6 （ IL - 6） , and tumor necrosis factor - α（ TNF -α） were measured Before and after 8 weeks＇ treat- ment. Results After treatment, the FBG of DS group decreased remarkably compared with group C and DA （ P 〈 0. 05）. The Serum TC, TG, and LDL - C of DA group were dropped and HDL - C elevated obviously compared with group C and DS（ P 〈 0. 01 ）. At the same time, the levels of urine α1 - MG , CRP, IL - 6 and TNF - α decreased significantly in the group DA and DS respectively compared with group C （ P 〈 0. 01 ） , the effect showed remarkable in the DS group than that in the DA group （ P 〈 0.05）. Conclusion Both Shenkangwan and Atorvastatin can reduce the DN patients＇ α1- MG in urine and serum levels of inflammatory cytokines, have protective effect of the kidney not dependent on hypoglycemic and lipid - lowering, the effect of the former is more obvious.