阿托伐他汀片对2型糖尿病肾病患者血清chemerin水平的影响

目的 观察长期口服HMG-CoA还原酶抑制剂阿托伐他汀片后2型糖尿病肾病(DN)患者尿白蛋白肌酐比值(ACR)和血清chemerin水平的变化,探讨HMG-CoA还原酶抑制剂改善DN尿蛋白的效果及机制.方法 收集海南医学院第一附属医院2015年1月至2016年12月门诊和住院诊断的60例DN患者,采用随机数表法将患者分为对照组和观察组,每组30例.两组患者均予以注射24周的胰岛素控制血糖,观察组同时给予阿托伐他汀片口服24周(20 mg/d).实验室检测两组患者治疗前后的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、血肌酐(Cr)、尿素氮(BUN)、ACR以及血清chemerin、肿瘤坏死因子-α(TNF-α)浓度.结果 治疗24周后,两组患者的BUN、Cr均无明显变化,而FBG、HbA1c均较治疗前明显下降,且差异均有统计学意义(P<0.05),但两组间下降程度比较差异均无统计学意义(P>0.05);对照组患者治疗后TG、TC、LDL无明显改变,但观察组则均明显下降,差异均有统计学意义(P<0.05);对照组和观察组治疗前的ACR分别为(173.32±71.23)μg/mg和(168.08±66.29)μg/mg,治疗后分别为(102.09±65.35)μg/mg和(72.08±41.33)μg/mg,两组患者治疗后的ACR均明显下降,但观察组下降较对照组更明显,差异均有统计学意义(P<0.05);治疗前对照组患者的血清chemerin和TNF-α分别为(48.17±11.25)ng/mL、(123.48±31.56)ng/mL,观察组分别为(45.08±11.36)ng/mL和(118.75±34.02)ng/mL,两组间比较差异均无统计学意义(P>0.05);治疗24周后,对照组患者的chemerin和TNF-α下降至(34.60±9.18)ng/mL和(94.66±30.33)ng/mL,观察组下降至(25.23±8.87)ng/mL和(69.20±25.12)ng/mL,治疗前后比较差异均有统计学意义(P<0.05),但是观察组chemerin和TNF-α下降更为明显(P<0.05).结论 长期口服阿托伐他汀片能显著降低DN患者血清的chemerin水平,改善尿蛋白滤过.

Effects of atorvastatin on the levels of serum chemerin in patients with type 2 diabetic nephropathy

Objective To observe the changes of urine albumin creatinine ratio (ACR) and serum chemerin lev-els in type 2 diabetic nephropathy (DN) after taking the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reduc-tase inhibitor atorvastatin for long time, to investigate the effect and mechanism of HMG-CoA reductase inhibitor in im-proving DN protein. Methods A total of 60 patients with DN, who admitted to the First Affiliated Hospital of Hainan Medical College from January 2015 to December 2016, were selected and divided randomly into the control group (n=30) and the observation group (n=30). The patients in both groups were given human insulin injection to control the blood glucose for 24 weeks. In addition, atorvastatin tablet was given in the observation group for 24 weeks (20 mg/d). The fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), serum creatinine (Cr), urea nitrogen (BUN), ACR and serum chemerin, tumor necrosis fac-tor-α(TNF-α) concentration in both groups before and after treatment were tested. Results Although BUN and Cr af-ter treatment for 24 weeks in both groups had no obvious change, FBG and HbA1c significantly decreased and the differ-ences were statistically significant (P<0.05). The TG, TC and LDL were not significantly changed after treatment in the control group, but they were significantly reduced in the observation group (P<0.05). The values of ACR of the observa-tion group and the control group were respectively (173.32 ± 71.23)μg/mg and (168.08 ± 66.29)μg/mg before treatment, which were significantly higher than (102.09 ± 65.35)μg/mg and (72.08 ± 41.33)μg/mg after the treatment, and the de-creasing in the observation group was more obvious than that in the control group (P<0.05). The serum chemerin and TNF-αin the control group before treatment were (48.17±11.25) ng/mL and (123.48±31.56) ng/mL, respectively, which were higher than (45.08±11.36) ng/mL and (118.75±34.02) ng/mL in the observation group, and the differences between the two groups were not statistically significant (P>0.05). After treatment for 24 weeks, serum chemerin and TNF-αin the control group dropped to (34.60±9.18) ng/mL and (94.66±30.33) ng/mL, while those dropped to (25.23±8.87) ng/mL and (69.20 ± 25.12) ng/mL in the observation group, and the differences before and after the treatment in both groups were statistically significant (P<0.05), but the decreasing in the observation group was more significantly than those in the control group (P<0.05). Conclusion Taking atorvastatin tablets for a long time could significantly reduce the serum levels of chemerin and improve the filtration of urine protein in patients with DN.