吡格列酮对2型糖尿病肾病患者骨桥蛋白和尿微量白蛋白的影响

Effects of pioglitazone on serum osteopontin and urinary microalbuminuria in type 2 diabetic patients with diabetic nephropathy

目的:探讨吡格列酮对2型糖尿病(T2DM)早期肾病患者血清骨桥蛋白(OPN)及尿微量白蛋白/尿肌酐比值(UMA/Cr)的影响。方法:90例T2DM患者按照2009年ADA糖尿病指南以UMA/Cr分为单纯糖尿病组(DM,UMA/Cr<30μg/mg)30例、糖尿病肾病组(DN,UMA/Cr:30～299μg/mg)60例,同时选择30名体检正常者为正常对照组。再将DN组随机分为吡格列酮组30例(吡格列酮30mg/d+胰岛素,n=30)和安慰剂组30例(安慰剂+胰岛素,n=30),随访治疗3个月。所有对象均测定血糖、血脂、肾功能、C反应蛋白(CRP)、OPN和UMA/Cr等。结果:吡格列酮组治疗3个月后,UMA/Cr[(35.02±6.38)μg/mg vs(86.30±12.21)μg/mg、P<0.01]、OPN[(394.24±19.43)ng/mL vs(457.00±15.21)ng/mL、P<0.01]及HbA1c、TG、CRP与安慰剂组比较均显著降低,差异有统计学意义。相关性分析显示△UMA/Cr(△:治疗前-治疗后的差值)与血清△OPN(r=0.673,P=0.000)呈显著正相关。结论:T2DM肾病患者血清OPN水平升高。吡格列酮能减少UMA/Cr水平,其部分可能是通过降低血清OPN水平实现的。

Objective To investigate the effect of pioglitazone on serum OPN and UMA/Cr in type 2 diabetic patients with diabetic nephropathy. Methods Ninety type 2 diabetes patients were divided into two groups randomly according to UMA/Cr of Standards of Medical Care in Diabetes of 2009, diabetes mellitus （DM, UMA/Cr 〈 30μg/mg, n = 30） and diabetic nephropathy （ DN,UMA/Cr： 30-299 μg/mg,n = 60）. Meanwhile, thirty healthy cases were selected for the Normal control （NC, n = 30）. Then DN were randomly divided into two groups： placebo group （placebo combined with Insulin therapy, n=30） and pioglitazone group （Pioglitazone combined with Insulin therapy, n = 30）. In all of the objectives, levels of glucose, lipid, renal function, CRP, OPN and UMA/Cr were examined and analyzed. Results After 3-month treatment, compared with placebo group, the levels of UMA/ Cr [（35.02 ＋ 6.38）vs （86.30±12.21）μg/mg, P〈 0.01], OPN [（394.24±19.43）vs （457.00±15.21）ng/mL, P 〈 0.01 ] and HbAIc, TG, CRP in pioglitazone group were significanct decreased, the difference was significance. In the pioglitazone group the levels of A UMA/Cr （△： the difference between before and after treatment） were correlated positively with A OPN （r = 0.673,P = 0.000）. Conclusions The level of OPN is significant increase in type 2 diabetic patients with diabetic nephropathy Pioglitazone can reduce level of UMA/Cr, may be achieve partly by reduce the level of serum OPN.