不同剂量阿托伐他汀对糖尿病肾病患者免疫及全身微炎症状态的影响

Effects of different doses of atorvastatin on immune and systemic inflammatory state in patients with diabetic nephropathy

目的探讨不同剂量阿托伐他汀对糖尿病肾病患者免疫与全身微炎症状态的影响。方法纳入我院2015年2月至2018年2月收治的糖尿病肾病患者120例,根据阿托伐他汀使用剂量分成小剂量组与大剂量组,每组60例。小剂量组阿托伐他汀剂量为10mg/d,大剂量组为20mg/d,两组均治疗16周。比较两组治疗效果,分别在治疗前、治疗16周末测定两组细胞免疫指标,包括CD4^+、CD8^+、CD4^+/CD8^+,检测患者的血清白介素4(IL-4)、IL-6、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平,并观察两组不良反应发生率。结果大剂量组总有效率为95.00%,高于小剂量组的83.33%,差异有统计学意义(P<0.05)。两组治疗后CD4^+、CD4^+/CD8^+水平均低于治疗前,CD8^+水平高于治疗前,且大剂量组CD4^+、CD4^+/CD8^+水平低于小剂量组,CD8^+水平高于小剂量组,差异有统计学意义(P<0.05)。大剂量组治疗后血清IL-4、IL-6、TNF-α、CRP水平低于小剂量组,差异有统计学意义(P<0.05)。大剂量组不良反应发生率为8.33%,小剂量组为3.33%,两组比较差异无统计学意义(P>0.05)。结论与小剂量阿托伐他汀相比,大剂量阿托伐他汀能进一步改善糖尿病肾病患者的免疫功能,减轻炎症反应,且未增加不良反应发生率。

Objective To investigate the effects of different doses of atorvastatin on immune and systemic inflammatory state in patients with diabetic nephropathy. Methods Totally 120 patients with diabetic nephropathy admitted to our hospital from February 2015 to February 2018 were included. According to the dosage of atorvastatin, they were divided into low -dose group ( n = 60) and high-dose group ( n = 60). The dose of atorvastatin in low -dose group was 10 mg /d, and in high-dose group it was 20 mg /d. The two groups were treated for 16 weeks. The therapeutic effects of the two groups were compared. Cellular immune indexes,including CD4 ^+,CD8 ^+,CD4 ^+/CD8 ^+,were measured before and after treatment for 16 weeks. Serum levels of interleukin-4 ( IL-4), IL-6, tumor necrosis factor-α( TNF-α) and C-reactive protein ( CRP) were also measured. The incidence of adverse reactions in the two groups was observed. Results The total effective rate in high-dose group was 95%, which was higher than 83. 33% in low -dose group ( P < 0. 05). After treatment,the levels of CD4 ^+ and CD4 ^+/CD8 ^+ in the two groups were lower than those before treatment,and the levels of CD8 ^+ were higher than those before treatment. The levels of CD4 ^+ and CD4 ^+/CD8 ^+ in high-dose group were lower than those in low -dose group,and the level of CD8 ^+ was higher than that in low -dose group ( P < 0. 05). The serum levels of IL-4, IL-6, TNF-α and CRP were lower in high-dose group than in low -dose group ( P < 0. 05). The incidence of adverse reactions was 8. 33% in high-dose group and 3. 33% in low -dose group. There was no significant difference between the two groups ( P > 0. 05). Conclusion Compared with low -dose atorvastatin,high-dose atorvastatin can further improve the immune function of patients with diabetic nephropathy,reduce inflammation,and does not increase the incidence of adverse reactions.