目的 通過研究丹參多酚酸鹽對老年糖尿病腎病的療效及對尿N-乙酰β-D-葡萄糖苷酶(NAG)、轉(zhuǎn)化生長因子-β₁(TGF-β₁)、單核細(xì)胞趨化蛋白-1(MCP-1)的影響,探討丹參多酚酸鹽治療糖尿病腎病的機(jī)制及糖尿病腎病發(fā)病過程中的關(guān)鍵因子.方法 90例糖尿病腎病患者隨機(jī)分為2組,每組45例,對照組給予常規(guī)治療,治療組在對照組的基礎(chǔ)上增加丹參多酚酸鹽治療,將200 mg注射用丹參多酚酸鹽加入200 mL生理鹽水中,靜脈滴注,1次/d,4周為1個療程.比較兩組患者的療效及NAG、尿微量白蛋白(mALB)、β₂-微球蛋白(β₂-MG)、TGF-β₁、MCP-1和生化指標(biāo)的變化.結(jié)果 治療后對照組和治療組的有效率分別為82.22%、91.11%,兩組比較差異具有統(tǒng)計學(xué)意義(P< 0.05).治療后,兩組的尿白蛋白排泄率(UAER)、肌酐(Cr)、血尿素氮(BUN)均較治療前明顯好轉(zhuǎn),且差異具有統(tǒng)計學(xué)意義(P< 0.01);與對照組治療后比較,治療組的UAER、纖維蛋白原(FIB)明顯改善,且差異具有統(tǒng)計學(xué)意義(P< 0.01).治療后,兩組的NAG、mALB、β₂-MG、TGF-β₁和MCP-1均明顯好轉(zhuǎn),與治療前相比差異具有統(tǒng)計學(xué)意義(P< 0.01);與對照組治療后比較,治療組的NAG、β₂-MG、TGF-β₁和MCP-1顯著改善,且差異具有統(tǒng)計學(xué)意義(P< 0.01),兩組的mALB差異不具有統(tǒng)計學(xué)意義.結(jié)論 丹參多酚酸鹽對糖尿病腎病的治療作用主要通過調(diào)節(jié)TGF-β₁和MCP-1水平、延緩近端腎小管損傷實現(xiàn).

Objective To study the effect of salvianolate in treatment of senile diabetic nephropathy and the effect on urine N-acetyl β-D-glycosidase enzymes (NAG), transforming growth factor-β₁ (TGF-β₁), monocyte chemoattractant protein-1 (MCP 1), to explore the mechanism of treating diabetic nephropathy and the key factors of salvianolate in treatment of diabetic nephropathy. Methods Patients (90 cases) with diabetic nephropathy were randomly divided into control and treatment groups. Each group had 45 cases. The patients in control group were treated with conventional therapy. The patients in the treatment group were iv administered with Salvianolate Injection (200 mg diluted with 200 mL physiological saline) on the basis of control group, once daily. One course of treatment was 4 weeks. The clinical efficacy and the changes of NAG, urine microalbumin (mALB), β₂-microglobulin (β₂-MG), TGF-β₁, MCP-1, and biochemical index of two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 82.22% and 91.11%, respectively, and there were differences between two groups (P <0.05). Urinary albumin excretion rate (UAER), creatinine (Cr), blood urea nitrogen (BUN) in two groups were improved significantly compared with those of control group, and the difference was significant (P <0.01). Compared with control group after treatment, UAER and fibrinogen (FIB) were improved with significant difference (P <0.01). NAG, mALB, β₂-MG, TGF-β₁ and MCP-1 were improved significantly compared with those of before treatment, and the difference was significant (P <0.01). Compared with control group after treatment, NAG, β₂-MG, TGF-β₁, and MCP-1 were improved with significant difference (P <0.01). There was no significant difference in mALB between two groups. Conclusion The therapeutic effect of salvianolate on diabetic nephropathy mainly works by regulating the levels of TGF-β₁ and MCP-1, and delaying the proximal renal tubular damage.