早期糖尿病肾病患者血尿转化生长因子β_1水平及干预研究

目的检测早期糖尿病肾病(DN)患者血和尿转化生长因子β1(TGF-β1)水平,比较氯沙坦、辛伐他汀以及两药联合治疗对早期DN患者TGF-β1的影响。方法选取糖尿病伴微白蛋白尿的患者65例,随机分为氯沙坦组、辛伐他汀组、氯沙坦联合辛伐他汀治疗组,另选取29名健康志愿者作为正常对照。12周后采用放射免疫法检测24h尿白蛋白排泄率(UAER),双抗体夹心酶联免疫吸附试验(ELISA法)检测血清和尿液TGF-β1水平。结果早期DN患者血和尿TGF-β1水平显著高于健康志愿者(P<0.01),且与UAER呈显著正相关(P<0.01)。与治疗前基础值相比,两药均能减少UAER以及血和尿中TGF-β1(P<0.05),以联合治疗更为明显。结论早期DN患者血和尿TGF-β1水平升高,氯沙坦、辛伐他汀以及氯沙坦联合辛伐他汀能有效降低TGF-β1,血和尿TGF-β1水平可作为DN早期诊断和治疗效果评估的较特异指标。

Determination and intervention of serum and urine transforming growth factor β1 levels in early diabetic nephropathy

Objective To determine the serum and urine levels of transforming growth factor β1(TGF-β1)in early diabetic nephropathy(DN)and to compare the effects of losartan,simvastatin and combination of the both on TGF-β1 in DN patients.Methods Sixty-five diabetic patients with microalbuminuria were randomly divided into 3 groups to receive losartan,or simvastatin,or combined losartan and simvastatin.Another 29 healthy individuals were included as controls.After 12 weeks,the patients were evaluated for 24-hour urinary albumin excretion rate(UAER)using radio-active immunoassay,serum/urine levels of TGF-β1 using double antibody sandwich ELISA assay.Results Compared with healthy controls,early DN patients showed significantly higher serum and urine levels of TGF-β1(P<0.01),which positively correlated with UAER(P<0.01).Therapy with losartan or simvastatin,particularly with the both combined,resulted in reduction of UAER and serum/urine TGF-β1 levels of baseline(P<0.05).Conclusion Losartan and simvastatin,alone or combined,showed significant reduction of serum and urine TGF-β1 levels found to be elevated in early DN.Levels of TGF-β1 may be used as a specific indicator for early diagnosis and treatment evaluation in DN.