CAJ | 학술논문

目的：通过研究丹参多酚酸盐对老年糖尿病肾病的疗效及对尿 N-乙酰β-D-葡萄糖苷酶（NAG）、转化生长因子-β1（TGF-β1）、单核细胞趋化蛋白-1（MCP-1）的影响，探讨丹参多酚酸盐治疗糖尿病肾病的机制及糖尿病肾病发病过程中的关键因子。方法90例糖尿病肾病患者随机分为2组，每组45例，对照组给予常规治疗，治疗组在对照组的基础上增加丹参多酚酸盐治疗，将200 mg注射用丹参多酚酸盐加入200 mL生理盐水中，静脉滴注，1次/d，4周为1个疗程。比较两组患者的疗效及NAG、尿微量白蛋白（mALB）、β2-微球蛋白（β2-MG）、TGF-β1、MCP-1和生化指标的变化。结果治疗后对照组和治疗组的有效率分别为82.22%、91.11%，两组比较差异具有统计学意义（P＜0.05）。治疗后，两组的尿白蛋白排泄率（UAER）、肌酐（Cr）、血尿素氮（BUN）均较治疗前明显好转，且差异具有统计学意义（P＜0.01）；与对照组治疗后比较，治疗组的UAER、纤维蛋白原（FIB）明显改善，且差异具有统计学意义（P＜0.01）。治疗后，两组的NAG、mALB、β2-MG、TGF-β1和MCP-1均明显好转，与治疗前相比差异具有统计学意义（P＜0.01）；与对照组治疗后比较，治疗组的NAG、β2-MG、TGF-β1和MCP-1显著改善，且差异具有统计学意义（P＜0.01），两组的mALB差异不具有统计学意义。结论丹参多酚酸盐对糖尿病肾病的治疗作用主要通过调节TGF-β1和MCP-1水平、延缓近端肾小管损伤实现。
목적：통과연구단삼다분산염대노년당뇨병신병적료효급대뇨 N-을선β-D-포도당감매（NAG）、전화생장인자-β1（TGF-β1）、단핵세포추화단백-1（MCP-1）적영향，탐토단삼다분산염치료당뇨병신병적궤제급당뇨병신병발병과정중적관건인자。방법90례당뇨병신병환자수궤분위2조，매조45례，대조조급여상규치료，치료조재대조조적기출상증가단삼다분산염치료，장200 mg주사용단삼다분산염가입200 mL생리염수중，정맥적주，1차/d，4주위1개료정。비교량조환자적료효급NAG、뇨미량백단백（mALB）、β2-미구단백（β2-MG）、TGF-β1、MCP-1화생화지표적변화。결과치료후대조조화치료조적유효솔분별위82.22%、91.11%，량조비교차이구유통계학의의（P＜0.05）。치료후，량조적뇨백단백배설솔（UAER）、기항（Cr）、혈뇨소담（BUN）균교치료전명현호전，차차이구유통계학의의（P＜0.01）；여대조조치료후비교，치료조적UAER、섬유단백원（FIB）명현개선，차차이구유통계학의의（P＜0.01）。치료후，량조적NAG、mALB、β2-MG、TGF-β1화MCP-1균명현호전，여치료전상비차이구유통계학의의（P＜0.01）；여대조조치료후비교，치료조적NAG、β2-MG、TGF-β1화MCP-1현저개선，차차이구유통계학의의（P＜0.01），량조적mALB차이불구유통계학의의。결론단삼다분산염대당뇨병신병적치료작용주요통과조절TGF-β1화MCP-1수평、연완근단신소관손상실현。
Objective To study the effect of salvianolate in treatment of senile diabetic nephropathy and the effect on urineN-acetylβ-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.