厄贝沙坦联合二甲双胍对早期糖尿病肾病患者肿瘤坏死因子受体1及单核细胞趋化蛋白-1的影响

Effects of Irbesartan and Metformin on tumor necrosis factor receptor 1 and monocyte chemotactic protein 1 in patients with early diabetic nephropathy

目的:探讨厄贝沙坦联合二甲双胍对早期糖尿病肾病患者肿瘤坏死因子受体1(Tumor necrosis factor receptor 1,sTNFR1)及单核细胞趋化蛋白-1(Monocyte chemotactic protein 1,MCP-1)的影响。方法:选择门诊接诊的162例早期糖尿病肾病患者,随机分为二甲双胍组、厄贝沙坦组以及联合用药组。二甲双胍组患者给予口服二甲双胍治疗,厄贝沙坦组给予厄贝沙坦组口服,联合用药组给予二甲双胍和厄贝沙坦治疗。连续治疗3个月后比较sTNFR1、高敏C反应蛋白、单核细胞趋化蛋白-1、糖代谢指标、蛋白尿以及血肌酐指标水平变化情况。结果:治疗后,三组sTNFR1、sICAM-1、hs-CRP、MCP-1水平较治疗前均有所降低,且联合用药组sTNFR1、sICAM-1、hs-CRP、MCP-1水平均低于二甲双胍组和厄贝沙坦组,差异具有统计学意义(P<0.05);3组糖化血红蛋白、空腹血糖水平较治疗前均有明显降低,且联合用药组低于二甲双胍组和厄贝沙坦组,差异具有统计学意义(P<0.05);联合用药组24h尿蛋白定量、尿清蛋白排泄率以及血肌酐低于二甲双胍组以及厄贝沙坦组,差异具有统计学意义(P<0.05)。结论:对早期糖尿病肾病患者实施二甲双胍联合厄贝沙坦治疗效果显著,能有效降低血清sTNFR1、MCP-1水平,减轻炎症反应,改善糖代谢水平和减轻蛋白尿水平。

Objective： To explore the effect of lrbesartan and Metformin on tumor necrosis factor receptor 1 and monocytc chcmoattractant protein 1 in patients with early diabetic ncphropathy. Methods： A total of 162 patients with early diabetic ncphropathy who had bccn admitted to the Hospital between February 2017 and February 2018 wcrc randomly assigned into Metformin group, lrbesartan group, and combination therapy group. The Metformin group was treated with oral Metformin, lrbesartan group was given oral lrbesartan for treatment, and the combination therapy group was treated with Metformin combined with lrbesartan. After 3 months of continuous treatment, the levels of sTNFR1, high sensitivity C reactive protein, monocyte chemoattractant protein 1, glucose metabolism index, proteinuria, and serum creatinine in the three groups were compared. Results： After treatment, the levels of sTNFR1, sICAM-1, hs-CRP, and MCP-1 in the three groups decreased compared with those before treatment, and the levels in the combination therapy group were all shown to be lower than those in the Metformin group and the lrbesartan group, with statistically significant differences （P〈0.05）. The levels of glycosylated hemoglobin and fasting blood glucose in the three groups were significantly lower than those before treatment, and those in the combination therapy group lower than the Metformin group and lrbesartan group, where the difference was statistically significant （P〈0.05）. The 24 hour urinary protein quantification, urinary albumin excretion rate, and serum creatinine in the combination therapy group were lower than those in the Metformin group and in the lrbesartan group, where the differences were statistically significant （P〈0.05）. Oonclusion： Metformin combined with lrbesartan is with significant curative effect for patients with early diabetic nephropathy, which can effectively reduce the levels of serum sTNFR1 and MCP 1 , relieve inflamma tion and improve glucose metabolism and proteinuria level.