阿托伐他汀治疗糖尿病肾脏病40例临床分析

目的观察阿托伐他汀治疗糖尿病肾脏病的疗效并探讨其机制。方法根据糖尿病肾脏病分期标准选取血糖控制达标的糖尿病肾脏病（临床分期Ⅲ期～Ⅳ期）患者60例，随机分成3组，各20例。I组为对照组，未使用他汀类药物；II、Ⅲ组为治疗组，分别给予阿托伐他汀20mg／d和40mg／d，共观察16周。分别检测治疗前及治疗后第6、12、16周血转化生长因子β1（TGF-β1）、超敏C反应蛋白、血清半胱氨酸蛋白酶抑制剂C、β2微球蛋白、血肌酐、血尿酸、总胆固醇、三酰甘油、24h尿蛋白水平。结果治疗后第12、16周，Ⅱ、Ⅲ组TGF-β1、超敏C反应蛋白、血清半胱氨酸蛋白酶抑制剂C、G2微球蛋白、血肌酐、血尿酸、总胆固醇、三酰甘油、24h尿蛋白水平较I组明显降低（P〈0．05），II组与Ⅲ组间差异有统计学意义（P〈0．05）。结论阿托伐他汀可能通过调节糖尿病肾脏病的脂代谢紊乱改善糖尿病肾脏病的微炎症状态，调节TGF-β1表达而抑制细胞外基质生成的作用途径来抑制糖尿病肾脏病肾间质纤维化，从而起到延缓肾功能减退的作用。

Clinical analysis of treatment effect of atorvastatin on patients with diabetic kidney disaease

Objective To observe therapeutic effect of atorvastatin in patients with diabetic kidney disaease （DKD） and to evaluate the mechanism. Methods Sixty patients with DKD （clinical 3 to 4 period） were randomly divided into 3 groups,20 in each group. Group I was control group, did not use statin. Groups II and III were treated with atorvastatin 20 mg/d and 40 mg/d properly. After 16 weeks,the serum levels of transforming growth factor-β1 （TGF-β1）, hs-C-reactive protein（hs-CRP）, serum cystatin C（CysC）, β2-microglobulin（β2-MG）, serum creatinin（SCr）, serum uric acid（UA）, total cholesterol（TC） ,triglycerides （TG） and 24-hour urinary albumin were detected before treatment and after treatment for 6,12,16 weeks. Results The serum levels of TGF-β1, hs-CRP,CysC,β2-MG, SCr, UA, TC, TG and 24-hour urinary albumin declined after 12 weeks and 16 weeks（P〈0. 05）. The serum level of TGF-β1, hs-CRP, CysC, β2-MG, SCr, UA, TC, TG and 24-hour urinary albumin of group II and III had significant statistical significance（P〈0. 05）. Conclusions The results show that atorvastatin may control the disturbance of lipoid metabolism of DKD and improve the state of micro-inflammatory. Atorvastatin may inhibit renal interstitial fibrosis of diabetic nephropathy through suppression of expression of TGF-β1 which can reduce extracellullar matrix production. Atorvastatin can delay the evolution of renal function of diabetic nephropathy.