吡格列酮对2型糖尿病患者尿单核细胞趋化蛋白1排泄的影响

The effect of pioglitazone treatment on urinary MCP-1 excretion in type 2 diabetic patients

目的探讨吡格列酮对2型糖尿病(T2DM)患者尿单核细胞趋化蛋白1(MCP-1)排泄的影响及意义。方法 90例T2DM患者随机分为吡格列酮干预组(DP组,44例)和磺酰脲类药物干预组(DS组,46例),观察12周,测定治疗前后两组的FBG、HbA_1c水平及UAlb/Cr(UACR)和尿MCP-1/Cr比值(UMCR)。结果 (1)基础时,两组指标差别无显著性;(2)治疗后两组FBG和HbA_1c均明显降低(P<0.01),但两组间无显著性差别;两组UMCR均明显降低(P<0.01和0.05),DP组UACR明显降低(P<0.01),DS组UACR轻度降低(P>0.05);与DS组相比较,DP组UACR和UMCR显著降低(P<0.05);(4)DM组患者UMCR水平与HbA_1c(r=0.652,P<0.01)和UACR(r=0.695,P<0.01)呈正相关。结论吡格列酮可能减轻肾组织局部增强的炎症反应,对糖尿病肾损伤提供保护作用。

Objective To observe the effects of pioglitazone therapy on urinary monocyte chemoattractant protein-1 （MCP-1） excretion in type 2 diabetics and to probe its possible reno-protective mechanisms. Methods 90 type 2 diabetic patients with fasting blood glucose （FBG） 7.0-13.0mmol/L and hemoglobin A1C （HbA1c） ≥7.0% were assigned randomly into group DP （pioglitazone add-on） and group DS （sulfonylureas add-on）. The levels of FBG, HbA1 c, urinary albumin to creatinine ratio （UACR） and urinary monocyte chemoattraetant protein-1 to ereatinine ratio （UMCR） were determined at baseline and at 12th week after treatments. Results （1） At baseline, there were no significant differences in FBG, HbA1 c,UACR and UMCR between the two groups; （2） After 12 weeks of treatment, the FBG and HbA1 c levels decreased obviously in both groups （P〈0.01）, however, there was no significant diffirence in the FBG and HbA1c levels between the two therapy groups. （3） Meanwhile, the UMCR was significantly delined in two groups （group DS, P〈0.05 and group DP, P〈0.01）. UACR was obviousely decreased in group DP （P〈0.01） and slightly decreased in group DS （P〉0.05）. Compared to group DN, the UACR and LIMCR were lowered significantly in group DP at the 12th week, （P〈0.05）. （4） The UMCR levels in DM group were positive associated with HbAlc （r=0. 652, P〈0.01）and UACR （r= 0. 695, P〈0.01）. Conclusions Pioglitazone can protect against kidney injury through lessening the increased inflammatory reaction in local kidney of type 2 diabetics.