Fluvastatin prevents nephropathy likely through suppression of connective tissue growth factor-mediated extracellular matrix accumulation

Diabetic nephropathy is related to glomerular extracellular matrix (ECM) accumulation that leads to glomerulosclerosis. Fluvastatin as a lipid-lowering medicine significantly prevents diabetic nephropathy, probably not only through its lipid-lowering action, but also mainly through its direct suppression of glomerular ECM accumulation. To test this hypothesis, in the present study, a five-sixths nephrectomized (5/6Nx) rat model to induce a renal ECM accumulation without coexistence of hyperlipidemia was used to investigate the effect of fluvastatin on renal function, glomerular ECM accumulation and expression of connective tissue growth factor (CTGF). 5/6Nx induced a significant nephropathy in rats at 13 weeks, indicated by renal dysfunction including increases in blood urine nitrogen, creatinine and urinary protein excretion, and renal histopathological changes. Administration of fluvastatin significantly prevented the renal dysfunction and histological abnormalities in the 5/6Nx rats. Furthermore, both significant suppression of matrix metalloproteinases (MMPs) activity such as MMP-2 and significant activation of tissue inhibitors of MMP (TIMPs) such as TIMP-2 observed in the 5/6Nx rats were almost completely prevented by fluvastatin, resulting in a significant prevention of glomerular ECM accumulation. For upstream mediator of ECM accumulation, 5/6Nx significantly up-regulated CTGF mRNA expression, but fluvastatin treatment prevented CTGF up-regulation. These results suggest that fluvastatin, as one of well-known lipid-lowering agents, plays an important role in the prevention of nephropathy, likely through suppression of CTGF-mediated ECM accumulation. Therefore, fluvastatin may be a potential candidate for developing a pharmaceutical approach to the prevention of diabetic nephropathy due to its both lipid-lowering and direct anti-renal ECM accumulation actions.     

安体舒通对实验兔动脉粥样硬化斑块的保护作用

目的探讨安体舒通对兔颈动脉粥样硬化斑块(CAP)模型的保护作用和机制。方法通过高脂喂养建立兔CAP模型,随机分为A组(对照组,n=20)、B组(来适可组,n=20)、C组(安体舒通 来适可组,n=20)三组。观察8周后各组CAP数量、形态、面积,纤维帽厚度、动脉中层厚度及斑块占管腔面积比。结果安体舒通联合来适可组能减少兔CAP的形成,增加其稳定性,使中膜厚度增加,纤维帽厚度减小,斑块占管腔总面积比变小。结论安体舒通对CAP有保护作用,能减少CAP形成,增加稳定性。     

氟伐他汀对大鼠心肌梗死后心室重塑的影响

目的:探讨羟甲基戊二酰辅酶A还原酶抑制剂氟伐他汀对SD大鼠心肌梗死后心室重塑的过程及心功能的影响。方法:SD大鼠冠状动脉前降支结扎形成心肌梗死,24h后存活的大鼠随机分成心肌梗死(AMI)对照组和氟伐他汀治疗组,治疗组予以氟伐他汀20mg·kg^-1·d^-1灌胃给药,对照组予以蒸馏水灌胃;另设假手术组。8周后进行心脏超声、血液动力学检测判定心脏功能和进行心脏形态学分析;同时检测血浆总胆固醇(Tch)、肌酐(Cr)、天冬氨酸氨基转移酶(AST),NO₂^-/NO₃^-、谷胱甘肽过氧化物酶(glutathioneperioxidase,GSH-PX)以及血浆、心肌脂质过氧化物(LPO)水平。结果:氟伐他汀组血浆Tch水平与AMI组比较没有显著性差异,平均主动脉压和心率差别无显著性,显著降低了左室舒张末压和减少了肺相对重量(P＜0.05);减少了右室相对重量、左室后壁厚度、肺相对重量和心肌纤维化(P＜0.05,P<0.01);降低了血浆和心肌的LPO的水平,抑制NO₂^-/NO₃^-的过度表达,增加了GSH-PX的表达(P＜0.05);血浆Cr和AST水平无显著差别(P＞0.05)。结论:氟伐他汀改善大鼠AMI后心室重塑,相对延缓心力衰竭的进展;氟伐他汀抗氧化机制可能参与这个过程。     

氟伐他汀抑制球囊损伤后兔的血管内膜增殖

目的：探讨兔髂动脉急性损伤后，氟伐他汀对血管内膜增殖的抑制作用及机制。 方法： 给新西兰大耳白兔行右髂动脉球囊导管内膜剥脱术，术后灌胃予氟伐他汀（8 mg·kg-1·d-1）治疗28 d，术前、术后3 h及3 d用放射免疫法测定血清中内皮素-1、血栓素A2和前列环素浓度；28 d后HE染色观察血管内膜增生情况，免疫组织化学方法检测细胞外基质的变化。结果： ① 兔髂动脉急性损伤后血清内皮素-1及血栓素A2浓度即明显增加，前列环素水平则显著下降；氟伐他汀治疗显著抑制内皮素-1和血栓素A2的升高；提高血清前列环素的水平；② 氟伐他汀治疗减轻了内膜TGF-β1的过度表达及细胞外基质（FN、LN）的沉积；③ 氟伐他汀显著抑制了内膜的增殖和肥厚。结论：氟伐他汀治疗抑制血管损伤后血栓的形成，减轻了内膜的增殖及内膜中细胞外基质的沉积。     

Efficacy and safety of high dose fluvastatin in patients with familial hypercholesterolaemia

Summary The efficacy and safety of the HMG CoA reductase inhibitor fluvastatin have been evaluated in a double blind study in 52 patients with familial hypercholesterolaemia. A standard AHA Phase II lipid lowering diet was prescribed throughout the study. After 6 weeks of a single blind dosage stabilisation period, in which patients received fluvastatin 40 mg qPM, patients were randomly allocated to one of two double blind treatment groups: group A (n=24) received fluvastatin 20 mg b. d. for 12 weeks and fluvastatin 20 mg AM + 40 mg PM for an additional 12 weeks; Group B (n=28) received fluvastatin 40 mg qPM during the entire study. Safety and tolerability were evaluated by the analysis of biochemical and haematological parameters, and ophthalmological and physical examinations. Efficacy was analysed by the determination of plasma lipids, lipoproteins and apoproteins.Fluvastatin 40 mg/d was associated with up to a 27.4% decrease in LDL-C and a 9.6% increase in HDL-C concentrations. Increasing the dose of fluvastatin from 20 mg b. d. to 60 mg per day in Group A was associated with a 7.1% decrease in LDL-C, a 12.1% increase of HDL-C and a 12.8% decrease in the LDL-C/HDL-C ratio. In comparison with Group B (40 mg qPM) LDL-C, HDL-C and the LDL-C/HDL-C ratio in Group A (60 mg) differed by –8.9%, 6.6% and –12%, respectively. During treatment with 40 mg qPM, one patient developed an asymptomatic but notable elevation of CK to 1823 U/l (normal range 0–100 U/l) that was caused by strenuous exercise. No other notable biochemical or haematological abnormalities were recorded.It is concluded that in patients with heterozygous FH the increase of fluvastatin from 40 to 60 mg/d provided an additional significant effect on plasma LDL-C and HDL-C levels and in the LDL-C/HDL-C ratio, without producing any deleterious effect.     

氟伐他汀对糖尿病大鼠肾脏核因子κB 表达的影响

目的:通过糖尿病大鼠模型,观察氟伐他汀对大鼠肾脏的保护作用。方法:SD大鼠随机分3组,即正常对照组、糖尿病组(DM组)、氟伐他汀治疗组。以链脲佐菌素(STZ)制备糖尿病大鼠模型,大鼠饲养4周分别取出肾脏检测NF-κB的表达。检测各组大鼠血糖、血脂2、4 h尿蛋白定量等指标。采用免疫组织化学技术检测各组肾小球中NF-κB的表达。结果:糖尿病大鼠肾小球NF-κB表达较正常肾组织增高,治疗4周后,小剂量氟伐他汀对血糖、血脂水平无影响,但可明显降低糖尿病肾病大鼠肾小球中NF-κB的表达,并减少蛋白尿。结论:氟伐他汀对糖尿病大鼠肾脏保护作用可能通过非依赖降脂的保护作用,其机制至少部分与下调肾小球中NF-κB表达有关。     

氟伐他汀对糖尿病小鼠肾脏白介素－６表达的影响

目的:探讨羟甲基戊二酰辅酶A还原酶抑制剂(HCRI)氟伐他汀对糖尿病小鼠肾脏白介素-6(IL-6)表达的影响.方法:以链脲佐菌素(STZ)诱导的CD-1小鼠糖尿病动物模型为研究对象.STZ腹腔注射60 ms.(ks·d),6～7天.6天后测血糖,血糖≥11.2 mmol/L为模型.造模成功后糖尿病小鼠随机分为氟伐他汀干预组5组(每组n=10),连续干预1～3个月,其中干预1个月组分为低剂量[5 ms/(ks·d)]、中剂量[25 ms/(ks·d)]和高剂量[125 ms/(ks·d)]组,干预2个月和3个月组均为中剂量,同时设糖尿病非干预组3组(每组n=10)和正常对照组3组(每组n=8).分别于干预1个月、2个月、3个月末处死相应各组小鼠,处死前收集尿标本,测血糖,记录小鼠体重,一侧肾重,留取血标本、肾组织.血清检测胆固醇、甘油三酯、尿素氮,尿液检测尿白蛋白/肌酐比值.ELISA法检测肾皮质中IL-6水平.结果:中剂量氟伐他汀连续干预2个月和3个月时,尿白蛋白/肌酐、血尿素氮、肾重/体重比值及IL-6水平均明显低于非干预组(P均<0.05),而在整个干预期间,血胆固醇及血甘油三脂水平各组间无显著差异(P>0.05).结论:氟伐他汀可抑制糖尿病小鼠肾脏IL-6水平的表达,降低蛋白尿,其肾保护作用独立于降脂以外且在一定剂量范围内呈时间依赖性.     

A patient with membranoproliferative glomerulonephritis diagnosed by the third biopsy via endocapillary proliferative glomerulonephritis and focal membranoproliferative glomerulonephritis

We present a girl with type I membranoproliferative glomerulonephritis (MPGN) diagnosed by the third renal biopsy. The first renal biopsy was performed at age 11.2 years after microscopic hematuria (which was revealed by school urinary screening) had persisted for 3 months, along with a low level of serum C₃. Pathological examination of the biopsied specimen revealed endocapillary proliferative glomerulonephritis with multiple humps. The serum C₃ level increased to within the normal range 2 months after the first renal biopsy, and the microscopic hematuria disappeared at age 12.3. However, microscopic hematuria, proteinuria, and the low serum complement level reappeared at age 12.8. Pathological examination of a further renal biopsy that was performed at age 13.2 revealed focal MPGN with humps. Prednisolone therapy was subsequently initiated. Fluvastatin was added to her treatment regime when she developed hypercholesterolemia at age 13.6 and was continued even after normal cholesterol levels were reestablished. Pathological examination of the third renal biopsy, which was performed at age 15.2, revealed type I MPGN with humps. Serum C₃ normalized 6 months after the cessation of prednisolone at age 15.9. It is clinically important that patients with nontypical acute glomerulonephritis should be observed over a long period and repeated renal biopsies should be performed.     

氟伐他汀联合非诺贝特治疗混合性高脂血症疗效观察

目的探讨小剂量氟伐他汀与非诺贝特联合应用治疗混合型高血脂症的临床疗效及安全性。方法混合型高血脂症患者182例,随机分为3组,即氟伐他汀组（40mg/d,n=60）、非诺贝特组（200mg/d,n=58）、联合治疗组（氟伐他汀40mg/d＋非诺贝特200mg/d,n=64）,治疗12周;观察治疗前后主要血脂水平的达标率及不良反应。结果12周时联合治疗组血清总胆固醇（TC）、低密度脂蛋白胆固醇LDL-C、三酰甘油（TG）下降的幅度均高于单独用药组（P〈0.05）;TC、LDL-C、TG3项全部达标率也高于单独用药组（P〈0.05）。联合治疗的不良反应与单独用药相比无明显增加。结论小剂量氟伐他汀（40mg/d）与非诺贝特（200mg/d）联合治疗混合型高血脂症,较单独用药更有效、更全面地改善各项血脂水平,具有良好的安全性和耐受性。     

氟伐他汀对5/6肾切除大鼠肾脏的保护作用

目的 :探讨羟甲基戊二酰辅酶 A( HMG- Co A)还原酶抑制剂氟伐他汀 ( fluvastatin)对 5 /6肾切除大鼠肾脏的保护作用。方法 :将 5 /6肾切除大鼠 2 4只随机均分为 5 /6肾切除组 ,模型组 ( n=1 2 )和氟伐他汀治疗的 5 /6肾切除组 ,治疗组 ( n=1 2 ) ,另设假手术组作为对照组 ( n=6)。处理 1 3周后检测尿蛋白排泄率、血清尿素氮、肌酐、总胆固醇和甘油三酯含量 ,光镜和电镜检查肾形态改变并计算肾小球硬化指数。结果 :氟伐他汀治疗组大鼠尿蛋白排泄率、血清尿素氮和肌酐水平较模型组明显降低 ,肾脏病变和肾小球硬化程度明显减轻。结论 :氟伐他汀对 5 /6肾切除大鼠肾脏病变具有一定的保护作用