丹参多酚酸盐治疗老年糖尿病肾病的临床研究

Clinical study of salvianolate in treatment of senile diabetic nephropathy

目的通过研究丹参多酚酸盐对老年糖尿病肾病的疗效及对尿N-乙酰β-D-葡萄糖苷酶(NAG)、转化生长因子-β1(TGF-β1)、单核细胞趋化蛋白-1(MCP-1)的影响,探讨丹参多酚酸盐治疗糖尿病肾病的机制及糖尿病肾病发病过程中的关键因子。方法 90例糖尿病肾病患者随机分为2组,每组45例,对照组给予常规治疗,治疗组在对照组的基础上增加丹参多酚酸盐治疗,将200 mg注射用丹参多酚酸盐加入200 m L生理盐水中,静脉滴注,1次/d,4周为1个疗程。比较两组患者的疗效及NAG、尿微量白蛋白(m ALB)、β2-微球蛋白(β2-MG)、TGF-β1、MCP-1和生化指标的变化。结果治疗后对照组和治疗组的有效率分别为82.22%、91.11%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组的尿白蛋白排泄率(UAER)、肌酐(Cr)、血尿素氮(BUN)均较治疗前明显好转,且差异具有统计学意义(P<0.01);与对照组治疗后比较,治疗组的UAER、纤维蛋白原(FIB)明显改善,且差异具有统计学意义(P<0.01)。治疗后,两组的NAG、m ALB、β2-MG、TGF-β1和MCP-1均明显好转,与治疗前相比差异具有统计学意义(P<0.01);与对照组治疗后比较,治疗组的NAG、β2-MG、TGF-β1和MCP-1显著改善,且差异具有统计学意义(P<0.01),两组的m ALB差异不具有统计学意义。结论丹参多酚酸盐对糖尿病肾病的治疗作用主要通过调节TGF-β1和MCP-1水平、延缓近端肾小管损伤实现。

Objective To study the effect of salvianolate in treatment of senile diabetic nephropathy and the effect on urineN-acetylβ-D-glycosidase enzymes （NAG）, transforming growth factor-β1 （TGF-β1）, monocyte chemoattractant protein-1 （MCP 1）, to explore the mechanism of treating diabetic nephropathy and the key factors of salvianolate in treatment of diabetic nephropathy.Methods Patients （90 cases） with diabetic nephropathy were randomly divided into control and treatment groups. Each group had 45 cases. The patients in control group were treated with conventional therapy. The patients in the treatment group were iv administered with Salvianolate Injection （200 mg diluted with 200 mL physiological saline） on the basis of control group, once daily. One course of treatment was 4 weeks. The clinical efficacy and the changes of NAG, urine microalbumin （mALB）,β2-microglobulin （β2-MG）, TGF-β1, MCP-1, and biochemical index of two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 82.22% and 91.11%, respectively, and there were differences between two groups （P＆lt; 0.05）. Urinary albumin excretion rate （UAER）, creatinine （Cr）, blood urea nitrogen （BUN） in two groups were improved significantly compared with those of control group, and the difference was significant （P ＆lt; 0.01）. Compared with control group after treatment, UAER and fibrinogen （FIB） were improved with significant difference （P ＆lt; 0.01）. NAG, mALB,β2-MG, TGF-β1 and MCP-1 were improved significantly compared with those of before treatment, and the difference was significant （P ＆lt; 0.01）. Compared with control group after treatment, NAG,β2-MG, TGF-β1, and MCP-1 were improved with significant difference （P ＆lt; 0.01）. There was no significant difference in mALB between two groups.Conclusion The therapeutic effect of salvianolate on diabetic nephropathy mainly works by regulating the levels of TGF-β1 and MCP-1, and delaying the proximal renal tubular damage.