硫辛酸对不同时期糖尿病肾病患者尿微量白蛋白及炎症的影响

Effect of lipoic acid on urinary microalbumin and inflammation in patients with diabetic nephropathy at different stages

目的探讨硫辛酸对不同时期糖尿病肾病患者尿微量白蛋白和炎症的影响。方法选取2015年7月至2017年12月在梅州市人民医院内分泌科住院治疗的2型糖尿病患者90例,根据24 h尿微量白蛋白排泄率(UAER)分为3组,即正常白蛋白尿组(NA,UAER<30 mg/24 h)、微量白蛋白尿组(MA,30 mg/24 h≤UAER<300 mg/24 h)和临床肾病组(CN,UAER≥300 mg/24 h);同时随机选取同期健康体检者30名作为正常对照组(NC)。再将3组糖尿病患者按随机数字表法随机分为等样本量的观察组和对照组,对照组给予常规治疗,观察组在常规治疗基础上给予注射用硫辛酸0.45 g加入0.9 %氯化钠注射液250 ml中避光缓慢静滴,1次/d,共2周。观察各组患者UAER、血清肌酐(SCr)、血糖、血清超敏C反应蛋白(hs-CRP)、血清肿瘤坏死因子α(TNF-α)水平的变化。结果2型糖尿病肾病患者血清hs-CRP、TNF-α水平明显高于正常对照组[(5.98±1.54)mg/L vs (6.49±1.84)mg/L vs(7.02±1.75)mg/L vs(2.95±0.86)mg/L;(17.19±5.05)ng/L vs(19.61±5.42)ng/L vs (20.25±6.23)ng/L vs (10.24±3.16)ng/L],差异具有统计学意义(F=15.63、25.22,P均<0.01),但糖尿病肾病不同时期比较差异无统计学意义;观察组经硫辛酸治疗后与对照组治疗后比较,其hs-CRP、TNF-α、SCr、UAER水平明显降低[(5.01±0.93)mg/L vs (3.89±0.72)mg/L,(5.51±1.23)mg/L vs (4.25±0.88)mg/L,(6.15±1.32)mg/L vs (4.78±1.01)mg/L;(15.59±4.19)ng/L vs (12.04±3.45)ng/L,(18.02±4.42)ng/L vs (14.43±4.22)ng/L,(18.67±4.88)ng/L vs (15.09±4.47)ng/L;(83.5±9.4)μmol/L vs (67.3±6.2)μmol/L,(85.6±16.0)μmol/L vs (61.3±16.7)μmol/L,(98.5±20.4)μmol/L vs (69.4±16.8)μmol/L;(16.5±7.4)mg/24 h vs(13.3±6.2)mg/24 h,(145.6±66.0)mg/24 h vs (106.3±56.7)mg/24 h,(805.5±166.4)mg/24 h vs(612.3±110.8)mg/24 h],差异具有统计学意义(t=3.689、3.227、3.192、2.526、2.275、2.095、5.572、4.069、4.265、5.597、2.051、3.742,P均<0.05)。结论2型糖尿病肾病患者存在炎症反应,硫辛酸可改善2型糖尿病肾病炎症状态,减少尿微量白蛋白排泄和降低血肌酐水平,从而达到肾保护作用。

Objective To investigate the effect of lipoic acid on urinary microalbumin and inflammation in patients with diabetic nephropathy at different stages. Methods Ninety patients with type 2 diabetes who were hospitalized at the Department of Endocrinology, Meizhou People's Hospital from July 2015 to December 2017 were selected, and they were divided into three groups according to 24-hour urinary albumin excretion rate (UAER): normal albuminuria group (NA group, UAER<30 mg/24 h), microalbuminuria group (MA group, 30 mg/24 h≤UAER<300 mg/24 h), and clinical nephropathy group (CN group, UAER≥300 mg/24 h). At the same time, we randomly selected 30 patients who underwent physical examination as a normal control group (NC group). Then, the three groups of diabetes patients were randomly and equally divided into an observation group and a control group using a random number table. The control group was given conventional treatment. The observation group was given 0.45 g lipoic acid for injection plus 0.9% sodium chloride injection 250 mL by slow intravenous infusion, once a day for 2 weeks. The changes of UAER, serum creatinine (SCr), blood glucose, hs-CRP, and TNF-α levels were observed. Results The levels of serum hs-CRP and TNF-α in the three groups of patients with type 2 diabetic nephropathy were significantly higher than those in the NC group [(5.98±1.54) mg/L,(6.49±1.84) mg/L,(7.02±1.75) mg/L vs (2.95±0.86) mg/L, F=15.63, P<0.01;(17.19±5.05) ng/L,(19.61±5.42) ng/L,(20.25±6.23) ng/L vs (10.24±3.16) ng/L, F=25.22, P<0.01];however, there was no significant difference among the three groups of patients with type 2 diabetic nephropathy. The levels of hs-CRP, TNF-α, SCr, and UAER were decreased significantly after lipoic acid treatment in the observation groups than in the control groups [(5.01±0.93) mg/L vs (3.89±0.72) mg/L,(5.51±1.23) mg/L vs (4.25±0.88) mg/L,(6.15±1.32) mg/L vs (4.78±1.01) mg/L, t=3.689, 3.227, 3.192, P<0.05;(15.59±4.19) ng/L vs (12.04±3.45) ng/L,(18.02±4.42) ng/L vs (14.43±4.22) ng/L,(18.67±4.88) ng/L vs (15.09±4.47) ng/L, t=2.526, 2.275, 2.095, P<0.05;(83.5±9.4)μmol/L vs (67.3±6.2)μmol/L,(85.6±16.0)μmol/L vs (61.3±16.7)μmol/L,(98.5±20.4)μmol/L vs (69.4±16.8)μmol/L, t=5.572, 4.069, 4.265, P<0.05;(16.5±7.4) mg/24 h vs (13.3±6.2) mg/24 h,(145.6±66.0) mg/24 h vs (106.3±56.7) mg/24 h,(805.5±166.4) mg/24 h vs (612.3±110.8) mg/24 h, t=5.597, 2.051, 3.742, P<0.05]. Conclusion The inflammatory reaction exists in type 2 diabetic nephropathy patients. Lipoic acid can protect the kidney by improving the inflammatory state of type 2 diabetic nephropathy, reducing urinary microalbumin excretion, and lowering serum creatinine levels.