吡格列酮干预对早期糖尿病肾病患者尿白蛋白排泄及hs-CRP表达的影响

摘要

目的：探讨吡格列酮干预对早期糖尿病肾病患者尿微量白蛋白及hs-CRP等指标的影响，分析其可能的作用机制。方法：选取2013年1月-2014年12月在本院住院治疗的2型糖尿病患者92例，所有患者均为早期糖尿病肾病患者，采用随机数字表法将其分为两组，对照组52例，治疗组40例，对照组保持原有口服降糖药或应用胰岛素降糖治疗，治疗组在原有降糖治疗基础上予以吡格列酮治疗。比较两组处理前后空腹血糖（FBG）、餐后2 h血糖（2 h BG）、空腹胰岛素（FINS）、胰岛素敏感指数（ISI）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）、糖化血红蛋白（HbA1c）、肝肾功能、24 h尿白蛋白排泄率（UAER）、超敏C反应蛋白（hs-CRP）、胱抑素C（CysC）、同型半胱氨酸（Hcy）等指标的变化。结果：对照组治疗后FBG、2 h BG、LDL-C、HbA1c、hs-CRP均较治疗前降低，比较差异有统计学意义（P<0.05）；治疗组治疗后Cr、ALT与治疗前比较差异无统计学意义（P>0.05），其余指标均优于治疗前且优于对照组治疗后，比较差异均有统计学意义（P<0.05）。结论：吡格列酮具有降糖、改善胰岛素抵抗、调脂、增加胰岛素敏感性、降低hs-CRP、减轻炎症反应及减少尿白蛋白排泄的作用。%Objective:To investigate the influence of Pioglitazone intervention on indexes such as urinary albumin excretion and hypersensitive c-reactive protein in patients with early diabetic nephropathy and its possible mechanism. Method:92 patients with type 2 diabetes hospitalized in our hospital from January 2013 to December 2014 were selected and randomly divided into two groups,with 52 patients in the control group and 40 patients in the treatment group.All patients were with early-stage diabetic nephropathy.The control group was given original oral medicines or insulin for treatment,the treatment group was given Pioglitazone for treatment on the basis of the original glucose-lowering therapy. The indexes such as the fasting blood glucose(FBG),2 hours blood glucose(2 h BG), fasting insulin(FINS), insulin sensitivity index(ISI),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),liver and renal function, 24 hours urinary albumin excretion rate(UAER),hypersensitive c-reactive protein(hs-CRP),cystatin c(CysC) and homocysteine(Hcy) of the two groups were compared before and after treatment.Result:After the treatment,the FBG,2 h BG,LDL-C,HbA1c and hs-CRP of the control group were lower than before treatment,the differences were statistically significant(P<0.05).In the treatment group,the differences in Cr and ALT before and after the treatment were not statistically significant(P>0.05),the other indexes after the treatment were better than before treatment and better than the control group,the differences were statistically significant(P<0.05).Conclusion: Pioglitazone can decrease the level of blood sugar,improve insulin resistance,regulate lipid metabolism,increase the sensitivity of insulin,diminish hs-CRP,reduce inflammatory reaction and urinary albumin excretion.