阿托伐他汀钙对Ⅲ～Ⅴ期糖尿病肾病患者的非依赖降脂性肾功能保护作用
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摘要
目的探讨阿托伐他汀钙对Ⅲ～Ⅴ期糖尿病肾病(DN)患者的非依赖降脂性肾功能保护作用。方法选取164例Ⅲ～Ⅴ期DN患者,随机分为对照组80例与研究组84例。两组均给予常规治疗,研究组同时给予阿托伐他汀钙治疗。治疗前及治疗4周及16周后,比较两组的C-反应蛋白(CRP)、血脂及肾功能,分析CRP与血肌酐、尿素氮、24 h尿蛋白的相关性,并记录不良反应发生情况。结果两组的CRP均随时间延长而降低,且在治疗4周及16周后研究组的CRP水平均低于对照组(均P <0. 05)。治疗4周及16周后,两组的血脂及肾功能指标均较治疗前改善,且研究组的TC、TG、LDL-C及肾功能指标水平均低于对照组(均P <0. 05),HDL-C水平高于对照组(均P <0. 05)。两组的CRP与血肌酐、尿素氮、24 h尿蛋白均呈正相关(均P <0. 05)。两组的不良反应发生率比较,差异无统计学意义(P>0. 05)。结论在常规治疗的基础上应用阿托伐他汀钙不仅可以更好地调节Ⅲ～Ⅴ期DN患者的血脂水平,还可以通过抗炎及改善微炎症状态等非依赖降脂作用发挥肾功能保护作用。
Objective To explore lipid-lowering-independent renal protection effect of atorvastatin calcium in patients with stage Ⅲ-Ⅴdiabetic nephropathy( DN). Methods A total of 164 patients with stage Ⅲ-Ⅴ DN were randomly allocated to control group( n = 80) or research group( n = 84). Both groups received routine treatment,with the research group were administrated with atorvastatin calcium additionally. Before treatment,after 4 weeks of treatment,and after 6 weeks of treatment,the C-reactive protein( CRP),blood lipids and renal function were compared between the two groups. The correlations of CRP with serum creatinine,urine nitrogen,and 24-hour urine protein were analyzed,and the incidence of adverse reactions was recorded. Results The CRP levels decreased by the time in both group,and the levels were lower in the research group than in the control group after 4 weeks and 6 weeks of treatment( all P < 0. 05).Blood lipids and renal function were improved in both groups,with TC,TG,LDL-C and renal function index lower and HDL-C higher in the research group than in the control group after 4 weeks and 6 weeks of treatment( all P < 0. 05). In both groups,CRP positively correlated with serum creatinine,urine nitrogen,and 24-hour urine protein( all P < 0. 05).There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion For patients with stage Ⅲ-Ⅴ DN,atorvastatin calcium on the basis of routine therapy can not only regulate the blood lipids levels better,but also exert a renal protective function by lipid-lowering-independent effect of anti-inflammatory and microinflammatory state improvement,etc.
Objective To explore lipid-lowering-independent renal protection effect of atorvastatin calcium in patients with stage Ⅲ-Ⅴdiabetic nephropathy( DN). Methods A total of 164 patients with stage Ⅲ-Ⅴ DN were randomly allocated to control group( n = 80) or research group( n = 84). Both groups received routine treatment,with the research group were administrated with atorvastatin calcium additionally. Before treatment,after 4 weeks of treatment,and after 6 weeks of treatment,the C-reactive protein( CRP),blood lipids and renal function were compared between the two groups. The correlations of CRP with serum creatinine,urine nitrogen,and 24-hour urine protein were analyzed,and the incidence of adverse reactions was recorded. Results The CRP levels decreased by the time in both group,and the levels were lower in the research group than in the control group after 4 weeks and 6 weeks of treatment( all P < 0. 05).Blood lipids and renal function were improved in both groups,with TC,TG,LDL-C and renal function index lower and HDL-C higher in the research group than in the control group after 4 weeks and 6 weeks of treatment( all P < 0. 05). In both groups,CRP positively correlated with serum creatinine,urine nitrogen,and 24-hour urine protein( all P < 0. 05).There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion For patients with stage Ⅲ-Ⅴ DN,atorvastatin calcium on the basis of routine therapy can not only regulate the blood lipids levels better,but also exert a renal protective function by lipid-lowering-independent effect of anti-inflammatory and microinflammatory state improvement,etc.
引文
[1]殷建,欧妍.阿托伐他汀对糖尿病肾病患者肾功能相关血清指标及肾脏纤维化的影响观察[J].河北医学,2015,21(1):49-52.
[2]杨丽华,罗俊辉,蒋洪敏.糖尿病肾病的微炎症状态与铁蛋白的研究进展[J].医学综述,2014,20(22):4 145-4 147.
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[5]Katzir Z,Leibovitch E,Vaknin H,et al. Effect of atorvastatin on Ig A nephropathy in the rat[J]. Clin Nephrol,2013,79(3):214-220.
[6]Moradi H,Said HM,Vaziri ND. Post-transcriptional nature of uremia-induced down regulation of hepatic apolipoprotein A-Ⅰproduction[J]. Transl Res,2013,161(6):477-485.
[7]Campese VM. Dyslipidemia and progression of kidney disease:role of lipid-lowering drugs[J]. Clin Exp Nephrol,2014,18(2):291-295.
[8]丁玲,胡毅,袁野.阿托伐他汀对早期糖尿病肾病患者血脂、炎性因子及肾功能的影响[J].中国药房,2015,26(15):2 035-2 037.
[9]任稹,张国召,王伟,等.不同剂量阿托伐他汀钙片对中老年2型糖尿病肾病患者转化生长因子β-1和尿蛋白的影响[J].北方药学,2017,14(3):11-12.
[10]李建英.不同剂量阿托伐他汀对老年早期糖尿病肾病患者炎症因子和胰岛素敏感性的影响[J].北方药学,2015,37(1):37-40.
[2]杨丽华,罗俊辉,蒋洪敏.糖尿病肾病的微炎症状态与铁蛋白的研究进展[J].医学综述,2014,20(22):4 145-4 147.
[3]刘章锁,张军军.他汀类药物在慢性肾脏病患者中的应用[J].肾脏病与透析肾移植杂志,2013,22(4):346-347.
[4]中华医学会糖尿病学分会微血管并发症学组.糖尿病肾病防治专家共识(2014年版)[J].中华糖尿病杂志,2014,6(11):792-801.
[5]Katzir Z,Leibovitch E,Vaknin H,et al. Effect of atorvastatin on Ig A nephropathy in the rat[J]. Clin Nephrol,2013,79(3):214-220.
[6]Moradi H,Said HM,Vaziri ND. Post-transcriptional nature of uremia-induced down regulation of hepatic apolipoprotein A-Ⅰproduction[J]. Transl Res,2013,161(6):477-485.
[7]Campese VM. Dyslipidemia and progression of kidney disease:role of lipid-lowering drugs[J]. Clin Exp Nephrol,2014,18(2):291-295.
[8]丁玲,胡毅,袁野.阿托伐他汀对早期糖尿病肾病患者血脂、炎性因子及肾功能的影响[J].中国药房,2015,26(15):2 035-2 037.
[9]任稹,张国召,王伟,等.不同剂量阿托伐他汀钙片对中老年2型糖尿病肾病患者转化生长因子β-1和尿蛋白的影响[J].北方药学,2017,14(3):11-12.
[10]李建英.不同剂量阿托伐他汀对老年早期糖尿病肾病患者炎症因子和胰岛素敏感性的影响[J].北方药学,2015,37(1):37-40.