阿魏酸钠联合阿托伐他汀对糖尿病肾病患者肾间质纤维化及炎症因子的影响

Effect of sodium ferulate combined with atorvastatin on the renal interstitial fibrosis and inflammatory cytokines in patients with diabetic nephropathy

目的:探讨阿魏酸钠联合阿托伐他汀对糖尿病肾病(diabetic nephropathy,DN)患者肾间质纤维化及炎症因子的影响。方法:选取DN患者111例为研究对象,随机分为观察组、对照1组和对照2组各37例。对照1组进行常规降糖、降压、优质低蛋白饮食;对照2组在对照1组基础上睡前口服阿托伐他汀20mg;观察组在对照1组基础上联合阿魏酸钠0.3g+0.9%氯化钠250mL静脉滴注,1次/d,睡前口服阿托伐他汀20mg。3组患者抽取治疗前后空腹外周静脉血,采用葡萄糖氧化酶(GOD)法测定空腹血糖(FPG);采用ELISA法测定血肌酐(SCr)、转化生长因子-β(TGF-β)、血管紧张素Ⅱ(AngⅡ)、结缔组织生长因子(CTGF)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6);放射免疫法测定血尿素氮(BUN)、24h尿白蛋白排泄率(24hUAER);增强化学发光免疫分析法测定Ⅳ型胶原(CⅣ)、Ⅲ型前胶原(PCⅢ)。记录平均动脉压(MAP)变化。结果:对照2组治疗后FPG、MAP、BUN、24hUAER、SCr低于对照1组(P<0.05),观察组治疗后FPG、MAP、BUN、24hUAER、SCr低于对照2组(P<0.05);对照2组治疗后AngⅡ、TGF-β、CTGF、PCⅢ、CⅣ低于对照1组(P<0.05),观察组治疗后AngⅡ、TGF-β、CTGF、PCⅢ、CⅣ低于对照2组(P<0.05);对照2组治疗后TNF-α、IL-6、hs-CRP低于对照1组(P<0.05),观察组治疗后TNF-α、IL-6、hs-CRP低于对照2组(P<0.05)。结论:阿魏酸钠联合阿托伐他汀可有效改善DN患者肾功能,减轻全身炎症反应,延缓肾间质纤维化速度。

Objective： To explore the effect of sodium ferulate in combined with atorvastatin on the renal interstitial fibrosis and inflammatory cytokines in patients with diabetic nephropathy （DN）. Methods： A total of 111 patients with DN who were admitted in our hospital from January, 2016 to April, 2017 were included in the study and randomized into the observation group and the control 1 and 2 group with 37 cases in each group. The patients in the control group were given routine blood sugar reducing, blood pressure reducing, and high quality low protein diet. On the above basis, the patients in the control 2 group were orally administrated with atorvastatin before sleep （20 mg）. On the basis of treatments in the control 1 group, the patients in the observation group were given sodium ferulate （0.3 g） ＋ 0.9% NaCl （250 mL）, ivdrip, 1 time/d, and administrated with atorvastatin before sleep （20 mg）. The fasting peripheral venous blood before and after treatment in the three groups was collected. The glycse oxidase （GOD） method was used to detect FPG. ELISA was used to detect SCr, TGF-β, Ang Ⅱ, CTGF, hs-CRP, TNF-α, and IL-6. RIA was used to detect BUN and 24hUAER. The strengthened chemiluminescence immunoassay was used to detect C Ⅳ and PC Ⅲ. MAP was recorded. Results： FPG, MAP, BUN, 24hUAER, and SCr after treatment in the control 2 group were significantly lower than those in the control 1 group （ P 〈0.05）. FPG, MAP, BUN, 24hUAER, and SCr after treatment in the observation group were significantly lower than those in the control 2 group （ P 〈 0.05）. Ang Ⅱ, TGF-β, CTGF, PC Ⅲ, and C Ⅳ after treatment in the control 2 group were significantly lower than those in the control 1 group （ P 〈0.05）. Ang Ⅱ, TGF-β, CTGF, PC Ⅲ, and C Ⅳ after treatment in the observation group were significantly lower than those in the control 2 group （ P 〈0.05）. TNF-α, IL-6, and hs-CRP after treatment in the control 2 group were significantly lower than those in the control 1 group （ P 〈0.05）. TNF-α, IL-6, and hs-CRP after treatment in the observation group were significantly lower than those in the control 2 group （ P 〈0.05）. Conclusions： The sodium ferulate in combined with atorvastatin can effectively improve the renal function in patients with DN, alleviate the systemic inflammatory reaction, and delay the renal interstitial fibrosis speed.