还原型谷胱甘肽对早期糖尿病肾病微炎症及尿清蛋白排泄率的影响

Effects of Reduced Glutathione on the Microinflammation and Urinary Albumin Excretion Rate of Incipient Nephropathy

目的观察还原型谷胱甘肽对早期糖尿病肾病(DN)患者炎症因子和尿清蛋白排泄率的影响。方法将60例DNⅢ期患者随机分为治疗组和对照组,所有患者均控制饮食、适当运动、采用胰岛素控制等一般对症治疗,治疗组患者同时静脉滴注还原型谷胱甘肽,1.2 g/d;对照组患者同时静脉滴注血塞通,1.2 g/d,均治疗4周。治疗前及治疗4周后检测血清C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-a(TNF-a)和尿清蛋白排泄率,以20例健康体检正常者作为正常对照组。结果治疗前两组患者的血CRP、IL-6、TNF-a水平均显著高于正常对照组,差异有统计学意义(P<0.01),而两组患者上述各指标水平间差异无统计学意义(P>0.05)。治疗4周后,对照组患者血清CRP、IL-6、TNF-a水平无明显改变(P>0.05),而治疗组患者血清CRP、IL-6、TNF-a水平均显著降低(P<0.05),但仍显著高于正常对照组(P<0.05)。治疗前两组患者的UAER间差异无统计学意义(P>0.05),治疗后两组患者的UAER间差异有统计学意义(P<0.05)。治疗后,治疗组UAER较治疗前显著降低(P<0.05),而对照组UAER治疗前后无显著变化(P>0.05)。结论早期DN患者存在炎症状态和血管内皮功能损伤,还原型谷胱甘肽可减轻DN患者的炎症状态,降低尿清蛋白排泄率,对早期DN患者有重要保护作用。

Objective To investigate the effects of reduced glutathione on inflammatory factors and urinary albumin excretion rate in treating incipient nephropathy among type 2 diabetic patients.Methods Sixty cases of type 2 diabetics with microalbuminuria were randomly assigned into two groups and all subjects received general treatment including diet control,exercises,and insulin.Patients in the trial group received reduced glutathione（1.2 g/d） intravenously for four weeks;while those in the control group received Xuesaitong（1.2 g/d） for four weeks the same way.Serum levels of C-reactive protein（CRP）,interleukin（IL-6）,tumor necrosis factor（TNF-α） and urinary albumin excretion rate（UAER） were measured before and after treatment.Twenty healthy subjects were also included in the study as controls.Results Serum CRP,IL-6 and TNF-α levels showed no differences between the two treating groups（P〈0.05）,but were significantly higher than those in the control group（P〈0.01）.After the 4-week treatment,levels of CRP,IL-6 and TNF-α were significantly decreased in the reduced glutathione group（P〈0.05）,though still higher than the control group（P〈0.05）.At the same time,no significant differences were noted between the Xuesaitong group and the control group（P〈0.05）.UAER between the two treatment group were of the same level before treatment（P〈0.05） and showed significant differences afterwards.（P〈0.05）.After treatment,UAER in the treatment groups decreased notably（P〈0.05） and remained unchanged in the control group（P〈0.05）.Conclusion Inflammation and endothelial dysfunction exist in DN patients with incipient nephropathy;Reduced glutathione can reduce the inflammatory status as well as decrease urine albumin excretion efficiently,which in turn may exhibit protective effects in DN patients with incipient nephropathy.