螺内酯联合百令胶囊对早期糖尿病肾病患者血清结缔组织生长因子和转化生长因子β_1表达的影响

目的探讨螺内酯联合百令胶囊对早期糖尿病肾病(DN)患者血清中结缔组织生长因子(CTGF)和转化生长因子β1(TGF-β1)水平的变化及其对肾脏的保护机制。方法选择早期2型DN患者60例,随机分为观察组和对照组,每组30例。2组患者均严格控制血糖、血压、血脂,给予血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂减少蛋白尿;在此基础上,观察组患者给予螺内酯20 mg.d-1,百令胶囊每日3次,每次1 g,疗程12周。检测2组治疗前后24 h尿蛋白和血肌肝(SCr)水平的变化,酶联免疫吸附法测定2组患者治疗前后CTGF和TGF-β1水平的变化。结果治疗后观察组24 h尿蛋白、SCr、CTGF及TGF-β1水平较治疗前明显降低,差异有统计学意义(P<0.01),对照组24 h尿蛋白、SCr、CTGF及TGF-β1水平变化不明显,差异无统计学意义(P>0.05);治疗后观察组患者24 h尿蛋白、SCr、CTGF及TGF-β1水平较对照组低,差异有统计学意义(P<0.01)。结论 CTGF和TGF-β1水平升高可能参与了DN肾脏纤维化的发展,螺内酯联合百令胶囊可通过降低CTGF和TGF-β1水平延缓DN进展。

Effect of spironolactone combined with Bailing capsule on connective tissue growth factor and transforming growth factor beta-1 in early diabetic nephropathy

Objective To investigate the effect of spironolactone combined with Bailing capsule on connective tissue growth factor(CTGF) and transforming growth factor beta-1(TGF-β1) in early diabetic nephropathy(DN).Methods Sixty patients with early DN were divided into control group and observation group,30 cases in each group.The patients in the two groups were all treated to control the blood sugar,blood pressure and blood fat,and they were given angiotensin converting enzyme inhibitor or angiotensinⅡreceptor antagonist to reduce the proteinuria.Based on these,the patients in observation group were given spironolactone 20 mg·d-1 and Bailing capsule three times a day with 1 g every time.One course of treatment was twelve weeks.The 24 hours urine protein and serum creatinine(SCr) were detected in the two groups before and after treatment.Serum CTGF and TGF-β1 levels were assayed by enzyme-linked immunosorbent assay before and after treatment.Results The levels of 24 hours urine protein,SCr,CTGF and TGF-β1 after treatment decreased in both control group and observation group compared with those before treatment,there were significant differences in treatment group(P<0.01) but not in control group(P>0.05).The levels of 24 hours urine protein,SCr,CTGF and TGF-β1 in observation group were lower than those in control group after therapy,there were significant differences(P<0.01).Conclusion The increasing levels of CTGF and TGF-β1 may participate progress of renal fibrosis in DN patients.Spironolactone combined with Bailing capsule can improve DN progress through decreasing the levels of CTGF and TGF-β1.