雷公藤多甙对糖尿病肾病患者微炎症反应的影响

目的探讨雷公藤多甙对糖尿病肾病患者微炎症反应的影响。方法将58例糖尿病肾病患者随机分为普通治疗组（DN组）和雷公藤多甙治疗组（TL组），共治疗3个月。Ficoll法分离外周血单个核细胞（PBMC）并于体外培养，观察雷公藤多甙对培养的PBMC的作用。用放射免疫法测定患者血清和PBMC上清液肿瘤坏死因子-α（TNF-α）和白细胞介素-1（IL-1）的浓度，EMSA测定PBMC核因子-κKB（NF-κB）的活性。选择20名性别、年龄匹配的健康者作为对照组（NO组）。结果①与NO组治疗前相比，DN组和TL组治疗前血自蛋白降低，24h尿蛋白定量升高，血TNF-α和IL-1升高（P〈0．05）。②治疗后，与DN组相比，TL组患者血白蛋白升高，24h尿蛋白定量降低，血TNF-α和IL-1降低（P〈0．05）。③与NO组治疗前相比，DN组和TL组治疗前PBMC基础分泌TNF-α和IL-1增加，PBMC NF-κB活性升高（P〈0．05）。雷公藤多甙处理后，PBMC分泌TNF-α和IL-1明显减少，NF-κB活性降低（P〈0．05）。结论雷公藤多甙通过抑制PBMC活性及循环微炎症反应发挥治疗糖尿病肾病作用。

Effect of triptolide on microinflammation in the patients with diabetic nephropathy

Objective To evaluate the effect of triptolide （TL） on microinflammation in the patients with diabetic nephropathy. Methods Fifty-five patients were randomly divided into two groups： DN group and TL group. Twenty normal individuals were selected as normal control group. Peripheral blood mononuclear cells （PBMC） were isolated by Ficoll method and cultured in vitro. The effects of TL on the cultured PBMC were observed. The levels of cytokines （TNF-α and IL-1） in serum and PBMC supernatants in the patients with diabetic nephropathy were determined by radioimmunoassay. The NF-kappaB activity in PBMC was measured by ELISA. Results （1）Compared with normal control group （before TL treatment）, the level of serum albumin was decreased and the total amount of 24 h urine albumin increased significantly; The levels of serum TNF-α and IL-1 were significantly higher in DN and TL groups. The secretion of TNF-α and IL-1 by PBMC was also increased markedly in DN and TL groups （P〈0.05）. Moreover, NF-kappaB in PBMC was activated significantly in DN group.（2）Compared with DN group （after treatment）, the level of serum albumin was increased and the total amount of 24 h urine albumin decreased significantly in TL group. The levels of serum TNF-α and IL- 1 were also significantly decreased. （3）Compared with normal control group （before treatment）, the activity of NF-kappaB and the basal secretion of TNF-α and IL-1 by cultured PBMC were increased markedly in DN and TL groups. These changes were inhibited significantly after TL （5μg/L） intervention （P〈0. 05）. Conclusions The effects of TL treatment on the patients with diabetic nephropathy were mediated by inhibiting the activity of PBMC and circulatory microinflammation.