α-硫辛酸及缬沙坦对糖尿病肾病氧化应激的调节作用

Effects of alpha-lipoic acid and valsartan on the oxidative stress in diabetic nephropathy

目的 观察a-硫辛酸、缬沙坦对糖尿病肾病（DN）患者氧化应激的调节作用。方法186名志愿者被纳入研究，包括健康对照组40例、单纯糖尿病组38例（DM组）、DNa-硫辛酸治疗组35例（DNA组）、DN缬沙坦治疗组40例（DNX组）、DN联合治疗组（DNAX组）33例，对纳入对象进行血清超氧化物歧化酶（SOD）、总抗氧化能力（T—AOC）、丙二醛（MDA）、晚期蛋白氧化物（AOPP）含量及尿微量白蛋白排泄率（UAER）的测定，分析比较DN与氧化应激的相关性及a-硫辛酸、缬沙坦对糖尿病肾病的疗效与作用机制。结果与对照组相比，治疗前DM、DN组血清MDA（4．64±0．47、4．97±0．43）mol／ml、AOPP（45．28±5．99、70．80±12．40）μmol／L均显著升高，SOD（92．62±7．48、80．92±5．98）U／ml、T—AOC（8．17±0．94、7．19±0．73）U／ml均显著降低（p〈0．05），以DN组最为明显，相关性分析显示UAER与MDA、AOPP呈正相关，与SOD、T—AOC呈负相关；治疗后DN各组血清MDA、AOPP及UAER较治疗前均显著降低，SOD、T—AOC显著升高（P〈0．05），以DNAX组MDA（3．95±0．52）mol／ml、AOPP（61．79±11．08）umol／L、SOD（89．35±9．57）U／ml、T—AOC（7．95±0．77）U／ml变化最为显著。结论氧化应激参与人体糖尿病及糖尿病肾病的发生发展，仅一硫辛酸联合缬沙坦能够有效改善机体的氧化应激状态，改善DN预后。

Objective To investigate the effects of alpha-lipoic acid and valsartan on the oxidative stress in diabetic nephropathy patients. Methods 186 volunteers were enrolled in the research, including 108 patients with the third stage of diabetic nephropathy （DN）, 38 patients with type 2 diabetes （DM） and 40 normal subjects （NC）. The DN group was randomly divided into three subset groups including alpha-lipoic acid intervention group （DNA）, valsartan intervention group （DNX） and alpha-lipoic acid combined with valsartan intervention group （DNAX）. The levels of SOD, T-AOC, MDA, AOPP and UAER were measured before and after the treatment. Results MDA, AOPP levels increased and SOD, T-AOC levels decreased significantly in the DC and DN groups compared with NC group before the treatment. MDA, AOPP levels increased and SOD, T-AOC levels decreased significantly in the DN group compared with DC group, there was a statistical significant difference （P〈0.05）. MDA, AOPP were positively correlated with UAER, and SOD, T-AOC were negatively correlated with UAER. The levels of MDA, AOPP and UAER in the DN group after the treatment with alpha-acid and valsartan decreased significantly than that of before, while the levels of SOD, T-AOC increased obviously（P〈0.05）. The analysis of subset groups investigated that the differences in the DNAX group were more significant than those of the other subset groups. Conclusion Oxidative stress plays an important role in the occurrence and development of diabetic nephropathy. Alpha-lipoic acid and valsartan can improve the oxidative stress state of human body and promote the prognosis of diabetic nephropathy.