不同剂量阿托伐他汀对老年早期糖尿病肾病患者炎症因子和胰岛素敏感性的影响

Effects of different doses of atorvastatin on inflammatory factors and insulin sensitivity among elderly patients with early diabetic nephropathy

目的观察不同剂量阿托伐他汀对老年早期糖尿病肾病(DN)患者外周血核因子-κB(NF-κB)p65(Ser536)的磷酸化水平、血清炎症因子水平及胰岛素敏感性的影响。方法将72例老年早期DN患者,随机分为两组,DN1组37例给予阿托伐他汀钙片10 mg/d,DN2组35例给予阿托伐他汀钙片20 mg/d,疗程均为16周。分别于治疗前后测定两组患者外周血NF-κB p65磷酸化水平、血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平及胰岛素抵抗指数(HOMA-IR)。结果两组患者治疗16周后hs-CRP、IL-6、IL-1β、TNF-α水平及HOMA-IR均较治疗前降低(P<0.05),DN2组降低更明显(P<0.05)。DN2组治疗后外周血NF-κB p65磷酸化水平较治疗前降低(P<0.05),而DN1组与治疗前比较,差异无统计学意义(P>0.05)。结论阿托伐他汀可降低早期DN患者外周血NF-κB p65的活性及hs-CRP、TNF-α、IL-6、IL-1β水平,降低HOMA-IR,改善患者炎症状态及胰岛素敏感性,且呈一定的剂量依赖性。

Objective To observe the effects of different doses of atorvastatin on the phosphorylation of nuclear factor-kappa B （NF-κB） p65 （Ser536） in peripheral blood, the levels of serum inflammatory factors, and insulin sensitivity among elderly patients with early diabetic nephropathy（DN）. Methods Seventy-two elderly patients with early DN were randomly divided into two groups ,37 cases in the DN1 group were given atorvastatin at a dose of 10 mg per day for 16 weeks,while 35 cases in the DN2 group were given atorvastatin at a dose of 20 mg per day for 16 weeks. The levels of phosphorylation of NF-κB p65 in peripheral blood, serum high-sensitivity C-reactive protein（hs-CRP） ,interleukin-6 （IL-6） ,interleukin1-β（IL-1β） and tumor necrosis factor-α（TNF-α） ,and insulin resistance index（HOMA-IR） were measured before and after treatment in two groups. Results After a sixteen-week treatment,the levels of hs-CRP,IL-6,IL-1β and TNF-α, and HOMA-IR decreased in two groups in contrast with those before treatment （ P 〈 0.05 ）, and the decrease in the DN2 group was more significant（P 〈0. 05）. The level of phosphorylation of NF-κB p65 in peripheral blood decreased significantly after treatment in DN2 group （P 〈 0. 05 ）, which showed no significant changes in the DN1 group after treatment in contrast with that before treatment （P 〉 0. 05 ）. Conclusion Atorvastatin can reduce the levels of NF-κB p65,hs-CRP,TNF-α,IL-6 and IL-1β,and HOMA-IR among patients with early DN. It may benefit the patients by improving inflammatory status and insulin sensitivity in a dose-dependent manner.