缬沙坦对早期糖尿病肾病患者血清转化生长因子β1水平的影响

Effects of valsartan on serum transforming growth factor-β1 levels in early diabetic nephropathy

目的 探讨血清转化生长因子β1（TGF-β1）与早期糖尿病肾病的相关性,同时阐明缬沙坦能否通过降低TGF-β1的水平发挥肾脏保护作用.方法 30例体检健康者作为对照组,66例合并糖尿病肾病的2型糖尿病患者分为正常白蛋白尿1组[尿微量白蛋白（UMA）/肌酐（Cr）〈10μg/mg]12例、正常白蛋白尿2组（UMA/Cr 10～30 μg/mg）19例和微量白蛋白尿组（UMA/Cr 31～300μg/mg）35例,伴有高血压者应用缬沙坦80 mg/d共4周.分别采血测定血清TGF-β1等指标.结果 正常白蛋白尿1组、正常白蛋白尿2组、微量白蛋白尿组患者血清TGF-β1水平分别为（7.41±2.68）、（10.52±4.10）、（22.98±43.74）ng/L,与对照组的（4.25±5.82）ng/L比较均明显升高（P〈0.05）,三组间比较差异也均有统计学意义（P〈0.05）,正常白蛋白尿1组中应用缬沙坦者血清TGF-β1水平较未用缬沙坦者明显下降[（5.77±1.90）ng/L比（8.23±8.78）ng/L]（P〈0.05）,其余两组应用缬沙坦者较未用缬沙坦者血清TGF-β1水平无明显下降.结论 血清TGF-β1水平升高与糖尿病及早期糖尿病肾病相关,早期应用缬沙坦可能通过降低血清TGF-β1的水平延缓糖尿病肾病的发生和发展.

Objective To investigate the relationship between serum transforming growth factor- β1（TGF- β1） levels and early diabetic nephropathy and clarify whether valsartan plays a role in renal protection by reducing the level of serum TGF-β1. Methods The study subjects were divided into four groups：control group （30 cases）; normal albuminuria group 1 （NA1 group with 12 cases, U MA/Cr 〈 10 μg/mg combined with type 2 diabetes）;normal albuminuria group 2 （NA2 group with 19 cases,UMA/Cr 10-30 μg/mg combined with type 2 diabetes）; microalbuminuria group （ MA group with 35 cases, U MA/Cr 31-300 μg/mg combined with type 2 diabetes）. All these type 2 diabetic patients were suffering from diabetic retinopathy, and valsartan （ 80 mg/d） were medicated for those combined with hypertension. The serum TGF-β1 levels were measured by enzyme-linked immunosorbent assay in all subjects. Results Serum TGF- β1 levels in three diabetes groups were （7.41 ± 2.68 ）, （ 10.52 ± 4.10）, （22.98 ± 43.74） ng/L, respectively, all of which were higher than those in control group [（4.25 ± 5.82） ng/L] （P 〈 0.05）. There were significant differences in serum TGF- β1 levels among MA group, NA2 group and NA1 group （P 〈 0.05 ）. Serum TGF-β1 levels in NA1 group with valsartan treatment significantly decreased compared with those without valsartan treatment （P 〈 0.05）, whereas there was no significant reduction in NA2 and MA group with valsartan treatment （P 〉 0.05）. Conclusions High serum TGF-β1 level may be associated with type 2 diabetes and early diabetic nephropathy. Early intervention of valsartan may be delay the onset and development of diabetic nephropathy by decreasing the serum TGF-β1 level.