还原型谷胱甘肽对早期糖尿病肾病微炎症及尿清蛋白排泄率的影响

摘要

目的 观察还原型谷胱甘肽对早期糖尿病肾病(DN)患者炎症因子和尿清蛋白排泄率的影响.方法 将60例DNⅢ期患者随机分为治疗组和对照组,所有患者均控制饮食、适当运动、采用胰岛素控制等一般对症治疗,治疗组患者同时静脉滴注还原型谷胱甘肽,1.2 g/d;对照组患者同时静脉滴注血塞通,1.2 g/d,均治疗4周.治疗前及治疗4周后检测血清C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子-a(TNF-a)和尿清蛋白排泄率,以20例健康体检正常者作为正常对照组.结果 治疗前两组患者的血CRP、IL-6、TNF-a水平均显著高于正常对照组,差异有统计学意义 (P＜0.01),而两组患者上述各指标水平间差异无统计学意义(P＞0.05).治疗4周后,对照组患者血清CRP、IL-6、TNF-a水平无明显改变(P＞0.05),而治疗组患者血清CRP、IL-6、TNF-a水平均显著降低(P＜0.05),但仍显著高于正常对照组(P＜0.05).治疗前两组患者的UAER间差异无统计学意义(P＞0.05),治疗后两组患者的UAER间差异有统计学意义(P＜0.05).治疗后,治疗组UAER较治疗前显著降低(P＜0.05),而对照组UAER治疗前后无显著变化(P＞0.05).结论 早期DN患者存在炎症状态和血管内皮功能损伤,还原型谷胱甘肽可减轻DN患者的炎症状态,降低尿清蛋白排泄率,对早期DN患者有重要保护作用.%Objective To investigate the effects of reduced glutathione on inflammatory factors and urinary albumin excretion rate in treating incipient nephropathy among type 2 diabetic patients.Methods Sixty cases of type 2 diabetics with microalbuminuria were randomly assigned into two groups and all subjects received general treatment including diet control , exercises , and insulin.Patients in the trial group received reduced glutathione ( 1.2 g/d ) intravenously for four weeks; while those in the control group received Xuesaitong ( 1.2 g/d ) for four weeks the same way.Serum levels of C - reactive protein ( CRP ).interleukin ( IL -6 ), tumor necrosis factor ( TNF - α ) and urinary albumin excretion rate ( UAER ) were measured before and after treatment.Twenty healthy subjects were also included in the study as controls.Results Serum CRP.IL - 6 and TNF - αlevels showed no differences hetween the two treating groups ( P ＞0.05 ), but were significantly higher than those in the control group ( P ＜0.01 ).After the 4 - week treatment, levels of CRP, IL - 6 and TNF - α were significantly decreased in the reduced glutathione group ( P ＜0.05 ), though still higher than the control group ( P ＜ 0.05 ).At the same time, no significant differences were noted hetween the Xuesaitong group and the control group ( P ＞0.05 ).UAER between the two treatment group were of the same level before treatment ( P ＞ 0.05 ) and showed significant differences afterwards.( P ＜ 0.05 ).After treatment, UAER in the treatment groups decreased notably ( P ＜ 0.05 ) and remained unchanged in the control group ( P ＞ 0.05 ).Conclusion Inflammation and endothelial dysfunction exist in DN patients with incipient nephropathy; Reduced glutathione can reduce the inflammatory status as well as decrease urme albumin excretion efficiently , which in turn may exhibit protective effects in DN patients with incipient nephropathy.