Cilostazol effectively attenuates deterioration of albuminuria in patients with type 2 diabetes: a randomized, placebo-controlled trial

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• 作者：Wen-Hao Tang (1)
  Fu-Huang Lin (2)
  Chien-Hsing Lee (1) (3)
  Feng-Chih Kuo (1)
  Chang-Hsun Hsieh (1)
  Fone-Ching Hsiao (1)
  Yi-Jen Hung (1) (2)
  
• 关键词：Adhesion molecules and diabetic nephropathy ; Cilostazol ; Microalbuminuria
• 刊名：Endocrine
• 出版年：2014
• 出版时间：March 2014
• 年：2014
• 卷：45
• 期：2
• 页码：293-301
• 全文大小：357 KB
• 作者单位：Wen-Hao Tang (1)
  Fu-Huang Lin (2)
  Chien-Hsing Lee (1) (3)
  Feng-Chih Kuo (1)
  Chang-Hsun Hsieh (1)
  Fone-Ching Hsiao (1)
  Yi-Jen Hung (1) (2)
  
  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chen-Kung Rd., Nei-Hu, Taipei, Taiwan
  2. School of Public Health, National Defense Medical Center, Taipei, Taiwan
  3. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
  
• ISSN：1559-0100

文摘

Cilostazol is an antiplatelet, antithrombotic agent with anti-inflammatory properties. To date, no clinical study has specifically evaluated the efficacy of cilostazol in patients with diabetic nephropathy (DN). We hypothesized that cilostazol might delay renal deterioration in DN patients at high risk of progression. Between April 2008 and April 2010, we screened 156 consecutive patients aged 35-0?years who were first diagnosed with type 2 diabetes after the age of 30?years. Of these, 90 patients with DN, as defined by morning spot urine microalbuminuria (MAU) >20?mg/L or an albumin-to-creatinine ratio (ACR) >30?μg/mg on at least two consecutive occasions within the prior 3?months, were enrolled into a 52-week randomized, single-blinded, placebo-controlled trial of oral cilostazol 100?mg twice daily or placebo (45 subjects in each group). Morning spot urine samples were collected to determine MAU and ACR. Fasting plasma levels of metabolic, endothelial variables, and inflammatory markers were examined. Following 52?weeks of treatment, urinary MAU and ACR were significantly reduced in the cilostazol group compared with the placebo group (P?=?0.024 and P?=?0.02, respectively). In regression analyses, changes in monocyte chemotactic protein-1, E-selectin, and soluble vascular cell adhesion molecule-1 (sVCAM-1) were significantly associated with changes in MAU and ACR. Net changes of E-selectin (P?<?0.001) and sVCAM-1 (P?<?0.05) were independent predictors of change in MAU and ACR, respectively. Our results suggest that cilostazol may effectively attenuate deterioration of albuminuria in patients with type 2 diabetes. This effect is likely mediated by an improvement of adhesion molecules.