摘要
目的探讨甘露聚糖结合凝集素（MBL）途径激活对糖尿病肾病（DN）合并高血压的影响，并探讨左旋氨氯地平对DN合并高血压患者的保护作用。方法选择2012年9月至12月泸州医学院附属医院肾内科就诊的DN合并高血压患者40例，按机数字表法分为试验组30例，对照组10例。两组均给予DN的常规治疗，试验组在常规治疗基础上口服左旋氨氯地平2．5mg，每日1次，如果2周后血压仍未降至正常（〉140／90mmHg，1mmHg=0．133kPa）则增加左旋氨氯地平用量至5mg，并联合应用降压药物；两组均连续用药90d。观察两组患者治疗前和治疗后30d和90d血压的变化及治疗前后血脂、肝肾功指标、外周血尿白蛋白排泄率（UAER）、MBL、糖化血红蛋白（HbAlc）、膜攻击复合物（MAC）的变化，并评价MBL与DN的相关性。结果试验组治疗后30d、60d血压均较治疗前下降[收缩压（mmHg）：157．4±8．6、145．6±7．5比167．6±11．4，舒张压（mmHg）：90．6±6．9、83．9±5．8比98．6±7．9，均P〈0．05]。两组治疗前后总胆固醇（Tc）、三酰甘油（TG）、高密度脂蛋白-c（HDL-C）、低密度脂蛋白-c（LDL-C）、糖化血红蛋白（HbAlc）、血肌酐（SCr）水平比较差异均无统计学意义（均P〉0．05o两组治疗后UAER、MBL和MAC均较治疗前明显下降，且试验组的下降程度较对照组更显著[UAER（mg／24h）为200．3±69．8比467．2±87．3，MBL（μg／L）为410±120比519±98，MAC（pg／L）为60±20比80±18，均P〈0．05]。相关性分析显示，血清MBL及尿MAC水平均与UAER呈正相关（FMBIJUAER=0．894，P=0．041；rMAC／UAER=0．908，P=0．032）。结论左旋氨氯地平对DN合并高血压患者具有保护作用，其机制与MBL途径相关。
Objective To study the effects of activation of mannose-binding lectin （MBL） pathway on diabetic nephropathy （DN） and hypertension, and discuss the protective effect of levoamlodipine on patients with DN and hypertension. Methods Forty patients with DN complicated with hypertension admitted to the Department of Nephrology of Luzhou Medical College Affiliated Hospital from September to December 2012 were enrolled, and they were randomly divided into experimental group （30 cases） and control group （lO cases）. The two groups were given conventional treatment for DN, the patients in the experimental group received levoamlodipine 2.5 mg, once a day, on the basis of conventional treatment, and after 2 weeks if the high blood pressure had not dropped to normal （〉 140/90 mmHg, l mmHg = 0.133 kPa）, the dosage of levoamlodipine was increased to 5 mg, or other antihypertensive drug（s） could be added in combination with levoamlodipine; the medication in two groups was continuously applied for 90 days. The changes of blood pressure were observed before and after treatment for 30 days and 90 days, the changes of blood lipids, liver and kidney functions, urinary albumin excretion rate （UAER）, MBL, glycosylated hemoglobin （HbA lc）, membrane attack complex （MAC） were detected before and after experiment in two groups, and evaluation of the correlation between DN and MBL was carried out. Results The blood pressure was lowered after treatment for 3 days and 60 clays compared to those before treatment in experiment group [systolic pressure （mmHg）： 157.4 ± 8.6, 145.6 ± 7.5 vs. 167.6 ±11.4, diastolic pressure （mmHg）： 90.6 ±6.9, 83.9 ± 5.8 vs. 98.6 ± 7.9, both P 〈 0.05]. The levels of total cholesterol （TC）, triglyceride （TG）, high density lipoprotein-cbolesterol （HDL-C）, low density lipoprotein-cholesterol （LDL-C）, HbAlc and serum creatinine （SCr） before and after treatment showed no statistical significant differences in the two groups （all P 〉 0.05）. The UAER, MBL and MAC were lower after treatment than those before treatment in both groups, and the degrees of descent in the experimental group were more obvious than those in the control group [UAER （mg/24 h）： 200.3 ± 69.8 vs. 467.2 ± 87.3, MBL （μg/L）： 410± 120 vs. 519± 98, MAC （pg/L）： 60 ± 20 vs. 80 ± 18, all P 〈 0.05）. Either the level of serum MBL or the level of urine MAC was correlated with UAER positively （rMBIIUAER =0.894, P = 0.041; rMBL/UAER = 0.908, P = 0.032）. Conclusion Levoamlodipine plays a protective role inpatients with DN and hypertension, and its mechanism is related to MBL pathway.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2016年第2期156-159,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
四川省医学会基金资助项目（川学会医字[2013]63）
作者简介
通讯作者：秦建华，Email：2582536740@qq．com
