银杏叶提取物联合缬沙坦治疗2型糖尿病肾病及对sTWEAK、NLR和IL-8的影响

发布时间：2018-05-03 19:14

本文选题：2型糖尿病肾病 + 肿瘤坏死因子样凋亡微弱诱导剂　；参考：《郑州大学》2017年硕士论文

【摘要】：背景与目的糖尿病肾病(Diabetic Nephropathy,DN)是常见的糖尿病(diabetes mellitus,DM)微循环受损的慢性并发症之一。据统计慢性肾脏病(chronic kidney disease,CKD)的主要病因就是DN,而且已经成为全球多数国家的终末期肾病(end-stage renal disease,ESRD)需要进一步透析治疗的首要病因。因此研究DN发病的机制及其治疗具有相当重要的意义。本研究通过观察银杏叶提取物注射液联合缬沙坦对2型糖尿病肾病血清肿瘤坏死因子样凋亡微弱诱导剂(sTWEAK),中性粒细胞与淋巴细胞的比值(NLR),血清IL-8的水平的变化,及评价银杏叶提取物联合缬沙坦治疗效果,探讨其对肾脏保护作用及可能机制。方法选取124例血清肌酐水平正常的2型糖尿病患者,根据Mogensen分级标准分为:单纯2型糖尿病组34例(T2DM组),微量白蛋白尿组患者46例(MAU组),大量白蛋白尿组患者44例(Ma AU组),并选取同时期的30例健康人群作为健康组(NC组),比较各组间sTWEAK、NLR和IL-8的差异;之后,MAU组和Ma AU组随机分为对照组和治疗组,对照组患者以常规治疗方案,包括控制饮食、适当运动、胰岛素降糖,并口服缬沙坦80mg/d治疗;治疗组患者在对照组的基础上,应用银杏叶提取物注射液20ml静滴QD,疗程3周,在治疗前后,比较sTWEAK、NLR和IL-8的水平并观察各组治疗效果。结果1.NC组、T2DM组、MAU组和Ma AU组IL-8、NLR水平逐渐升高,差异具有统计学意义(P0.001);sTWEAK水平逐渐降低,差异具有统计学意义(P0.001)。2.采用二元logistics回归,分别对影响2型糖尿病是否出现微量白蛋白尿和大量白蛋白尿的因素进行探讨。得知NLR和IL-8均为2型糖尿病出现微量白蛋白尿和大量白蛋白尿的独立危险因素,而血清sTWEAK为保护性因素。3.2型糖尿病肾病组中(MAU组和Ma AU组)IL-8、NLR、MAL(24小时尿微量蛋白)水平均呈正相关关系,而sTWEAK与上述因子呈负相关关系。4.治疗后,MAU组Ma AU组中血清IL-8、NLR、MAL的水平均明显降(P0.05),sTWEAK水平增高(P0.05);治疗组患者治疗后的MAL、IL-8、NLR的水平明显低于对照组治疗后的水平(p均0.05),sTWEAK明显高于对照组治疗后的水平(p0.05)。5.不论在MAU组还是Ma AU组,治疗组的总体有效率均高于对照组。结论血清sTWEAK,NLR,IL-8可作为2型糖尿病肾病肾损伤的敏感指标,对评估2型糖尿病肾病的发生和病情的进一步发展有重要意义;银杏叶提取物注射液联合缬沙坦具有保护肾脏作用,可能通过对微炎症的抑制作用从而治疗2型糖尿病肾病有良好的效果。
[Abstract]:Background & objective Diabetic Nephropathyne (DN) is one of the common chronic complications of diabetic diabetes mellitus (DM) with impaired microcirculation. According to statistics, the main cause of chronic kidney disease is DNs, and it has become the primary cause of end-stage renal disease (ESRD) in most countries in the world. Therefore, it is of great significance to study the pathogenesis and treatment of DN. The aim of this study was to observe the effects of ginkgo biloba extract injection combined with valsartan on serum tumor necrosis factor-like apoptosis (TNF-like), the ratio of neutrophils to lymphocytes and the level of serum IL-8 in type 2 diabetic nephropathy. To evaluate the therapeutic effect of Ginkgo biloba extract combined with valsartan and to explore its protective effect on kidney and its possible mechanism. Methods 124 patients with type 2 diabetes with normal serum creatinine levels were selected. According to the Mogensen classification standard, 34 patients with type 2 diabetes mellitus, 46 patients with microalbuminuria and 44 patients with large albuminuria were divided into three groups: 34 patients with type 2 diabetes mellitus, 46 patients with microalbuminuria and 44 patients with large amount of albuminuria. 30 healthy people of the same period were selected as the healthy group. The NLR and IL-8 of sTWEAKN were compared among different groups. Then the Mau group and MaAU group were randomly divided into two groups: the control group and the treatment group. The patients in the control group were treated with routine treatment, including diet control, proper exercise, insulin hypoglycemia, and oral valsartan 80mg/d treatment, and the patients in the treatment group were treated with valsartan 80mg/d on the basis of the control group. Ginkgo biloba extract injection 20ml was administered intravenously for 3 weeks. Before and after treatment, the levels of sTWEAKN NLR and IL-8 were compared and the therapeutic effects were observed. Results the levels of IL-8 NLR in 1.NC group were gradually increased, and the difference was statistically significant (P 0.001). The difference was statistically significant (P 0.001) and the difference was statistically significant (P 0.001) .2The results showed that the level of IL-8NLR in 1.NC group was higher than that in Mau group and Ma AU group, and the difference was statistically significant (P 0.001). The factors influencing microalbuminuria and large amount of albuminuria in type 2 diabetes mellitus were studied by binary logistics regression. Both NLR and IL-8 were independent risk factors for microalbuminuria and large albuminuria in type 2 diabetes. Serum sTWEAK was a protective factor in type 3.2 diabetic nephropathy group. The levels of IL-8 / NLRL in 24 hours urine microprotein in Mau group and Ma AU group were positively correlated, while sTWEAK was negatively correlated with the above factors. After treatment, the levels of serum IL-8 and NLRREAL in Ma AU group were significantly lower than those in the control group (P 0.05), and the levels of Mal IL-8 / NLR in the treatment group were significantly lower than those in the control group (P < 0.05) and the levels after treatment were significantly higher than those in the control group (P < 0.05). The total effective rate of the treatment group was higher than that of the control group both in MAU group and Ma AU group. Conclusion Serum sTWEAKN NLRR- IL-8 can be used as a sensitive index of renal injury in type 2 diabetes mellitus, and it is of great significance to evaluate the occurrence and further development of type 2 diabetic nephropathy, and that ginkgo biloba extract injection combined with valsartan can protect the kidney. It may have a good effect on type 2 diabetic nephropathy by inhibiting microinflammation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R692.9

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