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氯沙坦钾对糖尿病肾病患者chemerin、CRP、IL-6及ACR的影响
Effects of losartan potassium on Chemerin, CRP, IL-6 and ACR in patients with diabetic nephropathy

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DOI:
作者:
顾佩莉
Gu Peili
作者单位:
上海市浦东新区人民医院
Pudong New Area People’s Hospital
关键词:
糖尿病肾病，chemerin，C反应蛋白，白细胞介素－6，氯沙坦钾；尿蛋白/肌酐比值
【Keywords】 Diabetic nephropathy；chemerin；C-reactive protein； Interleukin-6；losartan potassium；Urinary albumin/creatinine ratio (ACR)
摘要:
【摘要】 目的：观察糖尿病肾病（diabetic nephropathy ，DN）患者经氯沙坦钾干预治疗后血清chemerin、C反应蛋白（C reactive protein ，CRP）、白细胞介素6（interleukin-6，IL-6）水平的变化，探讨氯沙坦钾保护肾功能的机理及临床意义。方法：122例DN患者随机分为试验组与对照组各61例，均给予常规基础治疗。试验组在常规治疗基础上加用氯沙坦钾（50mg/天），共治疗48周。观察两组患者治疗前和治疗后24周、48周血肌酐(serum creatinine，SCr) 、空腹血糖(Fasting Plasma Glucose,FPG）、胰岛素抵抗指数（HOMA-IR）、糖化血红蛋白（HbAIC）、血清chemerin、IL-6、 hs-CRP等指标。结果：1、试验组加用氯沙坦钾治疗24W、48W后，尿ACR与干预前比较下降有显著性差异（P<0.05或 P<0.01）；与对照组比较48W后试验组尿ACR下降更明显( P<0.05)。试验组的SCr呈明显下降趋势，与氯沙坦钾干预前比较治疗48W后有显著性差异( P<0.05)；与对照组比较试验组的SCr改善有明显差异( P<0.05)。2、试验组的HOMA-IR下降趋势明显，氯沙坦钾治疗后24W、48W均有显著性差异( P<0.05及P<0.01)。与对照组比较试验组的HOMA-IR改善在治疗24W、48W后均有显著性差异 ( P<0.05)。3、对照组在治疗24W和48W后chemerin、IL-6、 hs-CRP均无明显改变；试验组在加用氯沙坦钾治疗24W后chemerin、IL-6、 hs-CRP下降明显( P<0.05)，治疗48W后下降幅度更加明显( P<0.01)。组间比较chemerin、IL-6、 hs-CRP三个指标改变有显著性差异（P<0.05或P<0.01)。结论：氯沙坦钾改善肾功能可能与其抑制chemerin表达、改善胰岛素抵抗及减少炎症因子CRP、IL-6等水平密切相关。
【Abstract】Objective To observe the changes of serum Chemerin, C reactive protein (CRP), and Interleukin-6(IL-6) levels after treatment of losartan potassium on diabetic nephropathy (DN) patients, and explore the mechanism and clinical significance of the renal protection effect of losartan potassium. Methods: A total of 122 patients with type 2 diabetic nephropathy were randomly assigned to experimental group (n=61) and control group (n=61). All the patients undertook conventional treatment. Patients in the experimental group were treated with losartan potassium (50mg/day) for 48 weeks.we evaluated clinical parameters,Serum creatinine (SCR), fasting blood glucose (FPG), insulin resistance index (HOMA-IR), glycosylated hemoglobin (HBAIc), serum Chemerin, IL-6 and hs- CRP at 24 and 48 weeks after starting treatment.Results: 1. Levels of urine ACR in experimental group significantly decreased after 24W and 48W of losartan potassium treatment (P<0.05 and P<0.01), and also significantly lower than those in the control group 48 week after the treatment (P<0.05). The SCr in the experimental group significantly decreased comparing with the control group (P<0.05). 2. HOMA-IR in experimental group were significantly lower than that of control group after 24W and 48W (P<0.05 and P<0.01). Compared with the control group, the improvement of HOMA-IR in the experimental group were significantly different (P<0.05) after treatment with 24W and 48W. 3. No significantly change was observed in Chemerin, IL-6, hs-CRP in the control group after 24W or 48W of follow up. Levels of Chemerin, IL-6, and hs-CRP in experimental group significantly decreased after 24W(P < 0.05) and 48W (P < 0.01) of losartan potassium treatment. There were significant differences in changes of Chemerin, IL-6 and hs-CRP between two groups (P<0.05 or P<0.01). Conclusion:Our study indicated that Losartan potassium can improve renal function by inhibiting the expression of Chemerin, ameliorating insulin resistance and reducing the levels of inflammatory factors such as IL-6, CRP.

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