糖尿病肾病TGF-β_1,Ⅳ型胶原水平变化的临床意义及辛伐他汀的治疗作用

Clinical significance of level changes of TGF-β_1 and IV collagens and therapeutic effects of simvastatin in patients with diabetic nephropathy

目的 :探讨血清转化生长因子 β1 (TGF β1 ) ,Ⅳ型胶原水平变化在糖尿病肾病患者中的临床意义及其在辛伐他汀治疗后的变化 .方法 :糖尿病患者 80例根据尿白蛋白排泄率(UAER)分为糖尿病无肾病组 (A组 ) 36例和糖尿病肾病组 (B组 ) 4 4例 .B组接受辛伐他汀治疗 .分别采取所有患者于辛伐他汀治疗前和治疗后 6 ,1 2和 2 4wk的静脉血和 2 4h尿 .用ELISA法测定不同时期、用辛伐他汀治疗后糖尿病肾病患者血清TGF β1 ,Ⅳ型胶原水平 ,以黄柳酸比浊法测定 2 4h尿中总蛋白含量 .4 0例健康者作为对照组 .结果 :糖尿病患者血中TGF β1 ,Ⅳ型胶原水平较对照组明显升高 (A组均为P <0 .0 5 ,B组均为P <0 .0 1 ) ,B组较A组患者血中TGF β1 ,Ⅳ型胶原水平明显升高 (均为P <0 .0 5 ) .用辛伐他汀治疗后尿中蛋白含量减少 ,血中TGF β1 ,Ⅳ型胶原水平逐渐降低 .结论 :TGF β1 和IV型胶原可能在糖尿病肾病的发病过程中起重要作用 .辛伐他汀治疗糖尿病肾病的机制可能是通过抑制TGF β1

AIM: To investigate the clinical significance of changes in the levels of transforming growth factor β1 (TGF β1 ) and IV collagens, and the changes in the levels of TGF β1 and IV collagens after treatment with simvastatin in patients with diabetic nephropathy. METHODS: Eighty patients diagnosed as diabetic mellitus were chosen as subjects and were divided into two groups according to their urinary albumin excretion rate (UAER), of whom 44 were diabetic patients without nephropathy (group A) and 36 patients with diabetic nephropathy (group B). The patients in group B were treated with simvastatin. Venous blood samples were obtained in all patients before and after the administration of simvastatin for 6 weeks, 12 weeks and 24 weeks. The levels of TGF β1 and IV collagens were detected with ELISA at different times after patients with diabetic nephropathy were treated with simvastatin, and the levels of total urinary proteins per 24 h were also detected. 40 healthy subjects were used as controls. RESULTS: The levels of the serum TGF β1 and IV collagens in the diabetic patients were significantly higher than those in controls (group A vs control, all P < 0.05; group B vs control, all P <0.01). The levels of the serum TGF β1 and IV collagens in group B were significant higher than those in group A (both P < 0.05). After the administration of simvastatin, the levels of urinary proteins per 24 h decreased in group B, and the serum TGF β1 and IV collagens levels in group B progressively declined as the treatment with simvastatin continued. CONCLUSION: TGFβ1 and IV collagens may play an important role in the pathogenesis of diabetic nephropathy. Simvastatin may achieve its therapeutic effects in diabetic nephropathy by inhibiting the expression of TGF-1.