己酮可可碱对早期2型糖尿病肾病患者糖代谢、肾功能的影响及其作用机制

Effects of pentoxifylline on glucose metabolism and renal function in patients with early type 2 diabetic nephropathy

目的观察己酮可可碱对早期2型糖尿病肾病患者糖代谢、肾功能的影响,探讨其对肾脏的保护机制。方法将60例早期2型糖尿病肾病患者随机分为对照组30例和治疗组30例。2组均给予生活及饮食干预,并予以胰岛素控制血糖及调脂等治疗,血糖控制达标后,治疗组开始加用己酮可可碱缓释片治疗。治疗6个月后观察2组患者糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)]、肾功能指标[血肌酐(SCr)、尿白蛋白肌酐比值(UACR)]、氧化应激指标[活性氧(ROS)、丙二醛(MDA)、超氧化物歧化酶(SOD)]及α-Klotho蛋白水平的变化。结果2组治疗后FPG、2hPG、HbA1c、UACR与治疗前比较均明显降低(P均<0.05),且治疗组UACR明显低于对照组(P<0.05)。2组治疗后血清ROS、MDA水平与治疗前比较均明显降低(P均<0.05),且治疗组各指标水平均明显低于对照组(P均<0.05);2组治疗后血清SOD、α-Klotho蛋白水平与治疗前比较均明显升高(P均<0.05),且治疗组各项指标水平均明显高于对照组(P均<0.05)。结论己酮可可碱可以改善早期2型糖尿病肾病患者肾脏功能,机制可能与减轻氧化应激、调节α-Klotho蛋白水平有关。

Objective It is to observe the effects of pentoxifylline on glucose metabolism and renal function in patients with early type 2 diabetic nephropathy,and to explore its mechanism of protection on kidney.Methods Sixty patients with early type 2 diabetic nephropathy were randomly divided into control group(n=30)and treatment group(n=30).Both groups were given life and dietary interventions,and were treated with insulin for controlling blood sugar and the medicine for lipid-lowering.After the blood glucose control reached the standard,the treatment group began to add pentoxifylline sustained-release tablets.After 6 months of treatment,the changes of glucose metabolism indexes[fasting plasma glucose(FPG),postprandial 2 h plasma glucose(2hPG),glycosylated hemoglobin(HbA1c)],renal function indexes[serum creatinine(SCr),urinary albumin creatinine ratio(UACR)],oxidative stress indicators[reactive oxygen species(ROS),malondialdehyde(MDA),superoxide dismutase(SOD)]and the level ofα-Klotho protein were observed in the two groups.Results FPG,2hPG,HbA1c and UACR were significantly lower in the two groups after treatment compared with those before treatment(P<0.05),and the UACR in the treatment group was significantly lower than that in the control group(P<0.05).The levels of serum ROS and MDA after treatment were significantly lower than those before treatment in the two groups(P<0.05),and the levels of the indicators in the treatment group were significantly lower than those in the control group(P<0.05).The serum levels of SOD andα-Klotho after treatment were significantly higher than those before treatment in the two groups(P<0.05),and the levels of the indicators in the treatment group were significantly higher than those in the control group(P<0.05).Conclusion Pentoxifylline can improve renal function in patients with early type 2 diabetic nephropathy.The mechanism may be related to the reduction of oxidative stress and the regulation of level ofα-Klotho protein.