瑞舒伐他汀对2型糖尿病早期肾病患者血清炎性因子水平的影响

The effects of rosuvastatin on the serum level of hs-CRP, TNF-α, ICAM-1 in patients with the early-stage diabetic nephropathy

目的 探讨他汀类药物对早期糖尿病肾病的治疗作用及其机制.方法 60例伴或不伴血脂异常的2型糖尿病早期肾病患者完全随机分为瑞舒伐他汀组和常规治疗组,各30例,另选30例年龄、性别相匹配健康人作为健康对照组.治疗12周后比较3组患者血糖、血脂、Cr、BUN、高敏C反应蛋白（hs-CRP）、尿微量白蛋白排泄率（UAER）、肿瘤坏死因子α（TNF-α）、细胞黏附分子（ICAM-1）.结果 治疗前常规治疗组和瑞舒伐他汀组患者TC、LDL-C、TG、空腹血糖、餐后2 h血糖、24h UAER和hs-CRP明显高于健康对照组[分别为（5.96±1.12）、（6.08±1.39）mmol/L比（4.81±0.95）mmol/L,（3.54±0.65）、（3.51±0.58）mmol/L比（2.96±0.58）mmol/L,（10.46±1.87）、（11.29±1.92）mmol/L比（4.37±0.98）mmol/L,（9.32±2.17）、（9.87±1.56）mmol/L比（4.32±0.91）mmol/L,（14.92±2.46）、（15.48±2.1）mmol/L比（6.38±1.02）mmol/L,（94.2±32.5）、（96.2±35.9）μg/min比（16.6±8.4）μg/min,（2.36±0.54）、（2.42±0.61）mg/L比（0.68±0.39）ng/L,均P＜0.01],HDL-C水平明显降低,血清TNF-α、ICAM-1明显升高;治疗后瑞舒伐他汀组患者TC、LDL-C、TG水平[分别为（4.51±0.95）、（3.18±0.47）、（7.02±0.87）mmol/L]明显低于治疗前（P＜0.01）;治疗后常规治疗组和瑞舒伐他汀组患者24h UAER[分别为（78.3±31.7）、（53.8±24.9）μg/min]和hs-CRP水平[（2.15±0.48）、（1.59±0.55）mg/L]均明显下降（均P＜0.01）.治疗后瑞舒伐他汀组和常规治疗组患者的血清TNF-α、ICAM-1,均较治疗前明显下降,但以瑞舒伐他汀组下降程度更为明显.结论 瑞舒伐他汀可明显降低糖尿病肾病患者尿微量白蛋白排泄,在有效降脂的同时,可明显降低早期糖尿病肾病患者过高的血清hs-CRP水平,降低血清炎性递质TNF-α、ICAM-1水平,提示他汀类可通过抑制炎症过程,进而减少尿蛋白,保护肾功能.

Objective To investigate the protection effect of statins on the early-stage type 2 diabetic nephropathy. Methods Sixty patients of early type 2 diabetics nephropathy with or without lipid abnormality were randomly divided into two groups： rosuvastatin calcium treatment group （DNR） and regular treatment group （DN）.Thirty age and gender-matching healthy people were regarded as the healthy control group（NC）. The glucose, lipid,creatinine, blood urea nitrogen, high-sensitivity C-reactive protein （hs-CRP） , 24 h urinary micro-albumin serum level of tumor necrosis factor（TNF）-α, cell adhesion molecules （ICAM）-1 were measured. Results Before treatment, Total cholesterol （TC）, low-density lipoprotein cholesterol （LDL-C）, triglyceride （TG）, fasting blood glucose （FBS）, 2-hour postprandial blood glucose （PBS）, urine protein excretion rate （UAER）and CRP in DN and DNR patients were higher than those in NC patients. After treatment, the serum level of TC, LDLC, TG in patients in DNR group decreased significantly（P 〈 0. 01）. The UAER and CRP leve in DN and DNR groups decreased significantly. After the treatment, the serum level of TNF-α, ICAM-1 in DNR group and in DN group [（15.83 ±1.02） ng/L and（452.1 ± 171. 8）μg/L] also decreased significantly. Conclusions Rosuvastatin can significantly reduce the microalbuminuria excretion in diabetic nephropathy, effectively decrease the blood lipid, hs-CRP and inflammatory mediators such as TNF-α and ICAM-1 level, which indicates that statins can reduce urine protein and protect renal function by inhibiting the inflammatory process.