百令胶囊对尿蛋白阴性的糖尿病肾脏疾病患者踝肱指数、趾肱指数及氧化应激的影响

Effect of Bailing Capsule on Ankle Brachial Index,Toe Brachial Index and Oxidative Stress in Diabetic Nephropathy with Normoalbuminuria

目的:探讨尿蛋白阴性的糖尿病肾脏疾病发生可能的机制及百令胶囊的干预作用。方法:选择尿蛋白阴性的2型糖尿病患者200例,其中尿蛋白阴性的糖尿病肾脏疾病患者100例(NDN组),无白蛋白尿2型糖尿病患者肾功能正常患者100例(对照组)。比较两组的临床资料和实验室检查,Logistic回归分析肾功能下降的影响因素。NDN组分为常规治疗组、百令胶囊治疗组,每组50例,常规治疗组仅予胰岛素严格控制血糖,百令胶囊治疗组在常规治疗组治疗的基础上加用百令胶囊,5粒/次,3次/d,共服用8周,对比两组患者治疗前后检查的变化。结果:在尿蛋白阴性的糖尿病肾脏疾病患者中踝肱指数(ABI),趾肱指数(TBI),肾小球滤过率(e GFR)显著低于对照组[ABI(0.82±0.17)VS(1.07±0.51),TBI(0.64±0.16)VS(0.99±0.23),e GFR(49.5±6.5)VS(95.4±7.1)m L·min-1·(1.73 m2)-1,血清8-异前列腺素F2α(8-iso-PGF2α),颈动脉内中膜厚度(CIMT)显著高于对照组[8-iso-PGF2α(18.72±3.2)VS(8.21±1.9)μg·L-1,CIMT(1.13±0.19)VS(0.71±0.17)mm](P<0.05)。尿蛋白阴性的糖尿病肾脏疾病患者GFR与ABI,TBI呈显著正相关(P<0.05);8-异前列腺素F2α,ABI,TBI为尿蛋白阴性的糖尿病肾脏疾病患者的独立危险因素(P<0.005,P<0.001,P<0.001);百令胶囊治疗组治疗后ABI,TBI较常规治疗组改善更明显[ABI(0.98±0.35)VS(0.81±0.35),TBI(0.92±0.23)VS(0.62±0.22)],且差异有统计学意义(P<0.05),8-iso-PGF2α下降更明显[(9.34±2.8)VS(18.08±4.1)μg·L-1],且差异有统计学意义(P<0.05)。结论:尿蛋白阴性的糖尿病肾脏疾病发生可能与动脉硬化、氧化应激有关,使用百令胶囊干预能延缓其发展。

Objective： To determine the possible mechanism in diabetic nephropathy with normoalbuminuria and the effect of Bailing capsule on intervention. Method： Two hundred diabetes patients without micro albuminuria were selected and randomly divided into 2 groups,NDN group（ n = 100） and control group（ n =100）. Two groups were studied to compare the clinical data and laboratory results. Logistic regression analysis was used for the impacting factors of renal impairment. The NDN group was further divided into 2 groups： routine group（ n =50） was treated with insulin. The Bailing capsule group（ n = 50） was treated with Bailing capsule combined with insulin. After 8 weeks,the clinical data and laboratory results in two groups were compared before and after treatment. Result： Normoalbuminuria diabetic nephropathy patients showed that the ankle-brachial index（ ABI）,toe-brachial index（ TBI） and glomerular filtration rate（ e GFR） were lower than that of the control group [ABI（ 0. 82 ±0. 17） VS（ 1. 07 ±0. 51）,TBI（ 0. 64 ±0. 16） VS（ 0. 99 ± 0. 23）,e GFR（ 49. 5 ± 6. 5） VS（ 95. 4 ± 7. 1）m L·min-1·（ 1. 73 m2）-1]（ P〈0. 05）,serum 8-isoprostaglandin F2α（ 8-iso-PGF2α） and carotid intima-media thickness（ CIMT） were higher than that of the control group [8-iso-PGF2α（ 18. 72 ± 3. 2） VS（ 8. 21 ± 1. 9） μg·L-1,CIMT（ 1. 13 ±0. 19） VS（ 0. 71 ± 0. 17） mm]（ P〈0. 05）. GFR was significantly positively correlated with ABI and TBI in patients with normoalbuminuria diabetic nephropathy（ r = 0. 432,0. 374,P〈0. 05）. ABI,TBI and8-iso-PGF2αwere independent risky factors of renal impairment in patients with normoalbuminuria diabetic nephropathy（ P〈0.005,P〈0.001,P〈0.001）. After treatment,the 8-iso-PGF2αin the Bailing capsule group was decreased more significantly than routine group [（ 9. 34 ± 2. 8） VS（ 18. 08 ± 4. 1） μg·L-1]. After treatment the ABI,TBI in the Bailing capsule group was increased more significantly than routine group [ABI（ 0. 98 ± 0. 35） VS（ 0. 81 ± 0. 35）,TBI（ 0. 92 ± 0. 23） VS（ 0. 62 ± 0. 22） ]（ P〈0. 05）. Conclusion： The incidence of normoalbuminuria diabetic nephropathy may be associated with atherosclerosis and oxidative stress. The intervention with Bailing capsule can delay the development of normoalbuminuria diabetic nephropathy.