黄连素对2型糖尿病患者血清胱抑素C及尿微量白蛋白/肌酐比值的影响

Effects of berberine on the serum cystatin C levels and urine albumin/creatine ratio in patients with type 2diabetes mellitus

目的 探讨黄连素(小檗碱)对2型糖尿病患者血清胱抑素C(Cys C)及尿微量白蛋白/肌酐比值(UACR)的影响.方法 选择2015年1月至2016年1月在上海市第六人民医院金山分院内分泌科门诊或住院的114例既往2型糖尿病患者,其中男46例,女68例,年龄(55±14)岁,采用随机数字表法将患者随机分为干预组(57例)及对照组(57例),对照组降糖治疗方案为单用或联合应用降糖药物,干预组在对照组治疗基础上联合黄连素片口服(黄连素0.4 g/次,3次/d)治疗,两组连续治疗6个月,比较两组治疗前后UACR、血清Cys C及肝肾功能、血脂等生化指标的变化并评估黄连素的安全性.结果 治疗6个月后,干预组与对照组相比,糖化血红蛋白(HbA1c)、血尿素氮、收缩压、超敏C反应蛋白(hs-CRP)、红细胞沉降率(ESR)低,估算肾小球滤过率(eGFR)高,差异均有统计学意义(均P<0.05).干预组UACR较治疗前降低[47(26,120)mg/g比103(42,267)mg/g,P<0.001],且低于同期对照组[68(28,158)mg/g](P=0.039);干预组血清Cys C水平较治疗前下降[(0.83±0.30)mg/L比(0.98±0.25)mg/L,P=0.031)],且低于同期对照组[(0.96±0.30)mg/L](P=0.041).对照组治疗后UACR、Cys C水平与治疗前比较差异均无统计学意义(均P>0.05),干预组未见严重不良反应.多重线性回归分析结果显示,应用黄连素是UACR(β=-0.051,P=0.041)、Cys C(β=-0.068,P=0.033)下降的独立影响因素.结论 黄连素可改善2型糖尿病患者UACR及Cys C水平,且安全、有效.

Objective To investigate the effects of berberine on urine albumin/creatine ratio (UACR) and serum cystatin C (Cys C) in patients with type 2 diabetes mellitus (T2DM).Methods A total of 114 T2DM inpatients or outpatients , including 46 males and 68 females aged ( 55 ±14 ) years between January 2015 and January 2016 were randomly divided into two groups:the control group (n=57) only with hypoglycemic agents, and the intervention group (n=57) with berberine (0.4 g, 3 times a day) on the basis of treatment from the control group .Both groups were treated and followed up for six months . All the clinical and biochemical parameters were routinely evaluated before and after treatment .And the safety of berberine was assessed .Results After the treatment , the improvement of glycosylated hemoglobin (HbA1c), blood urea nitrogen ( BUN), systolic pressure ( SP), high sensitive C-reactive protein ( hs-CRP), rythrocyte sedimentation rate (ESR), estimated glomerular filtration rate (eGFR) in the intervention group were significantly better than those in the control group (all P<0.05), as well as the UACR[47(26, 120) mg/g vs 103(42, 267) mg/g, P<0.001]and serum Cys C[(0.83 ±0.30) mg/L vs (0.98 ±0.25) mg/L, P=0.031].However, there was no statistically significant difference of UACR and Cys C between before and after treatment in the control group (all P>0.05).Compared to the control group, the patients in the intervention group had lesser UACR [47(26, 120) mg/g vs 68(28, 158) mg/g, P=0.039], and lower serum Cys C[(0.83 ±0.30) mg/L vs (0.96 ±0.30)mg/L, P=0.041].Berberine had no obvious adverse effects. Multiple linear regression analysis revealed that the berberine administration was independently associated with the reduction of UACR (β=-0.051, P=0.041) and Cys C (β=-0.068, P=0.033) in T2DM patients.Conclusion Berberine improves diabetic kidney disease by reducing UACR and serum Cys C in T2DM patients, and it was safe.