吡格列酮干预对2型糖尿病患者尿细胞间粘附分子-1排泄的影响

目的观察吡格列酮对2型糖尿病患者尿细胞间粘附分子-1(ICAM-1)排泄的影响,探讨其肾脏保护机制。方法 98例2型糖尿病患者(完成为90例)随机分为吡格列酮干预组(DP组,44例)和磺酰脲类药物干预组(DS组,46例),分别加用吡格列酮和磺酰脲类药物。治疗前和治疗后第12周,测定两组的空腹血糖(FBG)、糖化血红蛋白(HbA1c)水平及尿白蛋白/肌酐(Alb/Cr)和尿ICAM-1/Cr比值。结果 (1)基础状态时,DP组和DS组FBG、HbA1c水平及尿Alb/Cr和ICAM-1/Cr比值均高于NC组(P<0.01),但DP组和DS组间上述各相关差异无统计差异(P>0.05);(2)治疗后,DP组和DS组FBG及GHbA1c水平较基线值明显下降(P<0.01),两组间各指标差异无统计意义(P>0.05);(3)与治疗前相比,DP组尿Alb/Cr水平明显降低,差异显著(P<0.01),而DS组尿Alb/Cr水平仅轻度降低,差异无显著性(P>0.05);(4)治疗后,DP组尿ICAM-1/Cr明显下降(P<0.01),DS组有所下降,但无统计意义(P>0.05);与DS组比较,治疗后DP组尿ICAM-1/Cr水平显著降低(P<0.05);5)DP组和DS组患者尿ICAM-1/Cr水平与尿Alb/Cr水平呈正相关(r=0.705,P<0.01)。结论吡格列酮可降低尿ICAM-1的排泄,减轻肾组织局部增强的炎性反应,对糖尿病患者肾脏起到保护作用。

The effects of pioglitazone on ICAM-1 excretion in type 2 diabetics patients

Objective To observe the effects of TZD-pioglitazone on intercellular adhesion molecule-1（ICAM-1）excretion in Type 2 diabetics and to probe into its possible reno-protective mechanisms.Methods 98 uncontrolled Type 2 diabetic patients with FBG 7.0～13.0mmol/L and HbA1c≥7.0% were assigned randomly into group DP （pioglitazone add-on） and group DS （sulfonylureas add-on）.Fasting blood glucose （FBG）,Glycosylated hemoglobin A1c （GHbA1c）,urinary albumin/creatinine （Alb/Cr） and urinary ICAM-1/Cr levels were determined at baseline and the 12th week.Rusults 1） At the baseline,FBG,HbA1c,Alb/Cr and urinary ICAM-1/Cr ratio in group DP and group DS were much higer than those in NC;however,there were no significant differences of above parameters between group DP and group DS;2） After 12 weeks treatment,the FBG and GHbA1c levels decreased obviously in group DP and group DS （P〈0.01）,however,there was no significant diffirence between the two groups;3） Compared to pre-therapy,urinary Alb/Cr was significantly delined in group DP （P〈0.01） and slightly decreased in group DS （P〉0.05）;4） Compared to pre-therapy,urinary ICAM-1/Cr were lowered obviously in group DP （P〈0.01）,however no significant difference presented in group DS;5） Urinary ICAM-1/Cr levels were positive associated with Alb/Cr （r=0.705,P〈0.01）.Conclusion Pioglitazone can protect against kidney injury through lessening the increased inflammatory reaction in local kidney of type 2 diabetics.