糖尿病肾病患者血清炎症因子与肾素血管紧张素系统的监测及意义

Significance of serum inflammatory factors and reninangiotensin system in patients with diabetic nephropathy

目的探讨炎症因子和肾素血管紧张素系统改变在糖尿病肾病发病和治疗中的作用。方法 112例首诊的糖尿病患者分别在入院第2日和治疗后第10周门诊复查时测定IL-6、CRP、PRA、AngⅡ及尿白蛋白排泄率。结果 112例糖尿病患者中,正常白蛋白尿组58例、微量白蛋白尿组37例和临床白蛋白尿组17例的IL-6、CRP、PRA、AngⅡ水平均依次增高(P<0.05)。IL-6、CRP、PRA、AngⅡ水平和尿白蛋白排泄率均呈正相关(P<0.05)。治疗10周后,IL-6、CRP、PRA及AngⅡ均较治疗前下降(P<0.05);并且IL-6、CRP、PRA及AngⅡ水平的下降以治疗显效组最为明显(P<0.05)。结论炎症与肾素血管紧张素系统的过度激活以及二者相互影响可能在糖尿病肾病发病中起重要作用,并且糖尿病肾病的治疗效果也和炎症与肾素血管紧张素系统激活的改善状况有关。

[ Objective] To investigate the changes of inflammatory factors and renin-angiotensin system in diabetic nephropathy and access the pathogenesis. [Methods] IL-6, CRP, PRA, Ang Ⅱ and urinary albumin excretion rate were determined in 112 patients with diabetes meMtus at the second day in hospital and after 10 weeks of treatment, respectively. [Results] Among 112 diabetes patients, there were 58 patients of normal albuminuria, 37 patients of microalbuminuria, 17 patients of clinical albuminuria. The level of IL-6, CRY, PRA, Ang Ⅱ were increased gradually in this three groups （P 〈0.05）. IL-6, CRP, PRA, Ang Ⅱ levels and urinary albumin excretion rate were positively correlated （P 〈0.05）. After 10 weeks of treatment, IL-6, CRP, PRA and Ang Ⅱ decreased compared with those before treatment （P 〈0.05）; and IL-6, CRP, PRA and Ang Ⅱ were markedly decreased in the markedly group （P 〈0.05）. [Conclusion] The excessive activation of inflammation and renin-angiotensin system, as well as the interaction, may play an important role in the pathogenesis of diabetic nephropathy , and the results of the treatment of diabetic nephropathy may related to the improved situation of inflammation and reninangiotensin system activation.