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目的 研究氟伐他汀对2型糖尿病肾病患者血浆脂蛋白(a)[Lp(a)]的作用及其临床意义。方法2001-10～2003-10河北医大三院104例2型糖尿病肾病患者尿白蛋白排泄率在20～200μg/min之间,随机分成氟伐他汀治疗组(20mg,每晚1次口服)和对照组,各52例,观察6周。采用ELISA方法测定血浆,发色底物法测定纤溶酶原激活物抑制剂-1(PAI-1)及组织型纤溶酶原激活物(tPA)活性,留24h尿测定内生肌酐清除率(Ccr)。结果 所有入选对象血浆Lp(a)水平均异常增高,纤溶功能受抑制,Ccr处于高水平。治疗6周后血浆Lp(a)下降(P<0.05),血浆PAI活性减弱,tPA活性升高,纤溶功能明显改善,Ccr降至正常。结论 氟伐他汀能下调Lp(a),进而改善纤溶功能,缓解肾小球高滤过状态,发挥肾脏保护作用。
Objective To investigate the effect of fluvastatin on plasma lipoprotein (a) [Lp (a)] in type 2 diabetic nephropathy and its clinical significance. Methods The urinary albumin excretion rate of 104 patients with type 2 diabetic nephropathy from Hebei Medical University Hospital from October 2001 to October 2003 was between 20 and 200 μg / min. The patients were randomly divided into two groups: fluvastatin treatment group (20 mg orally once daily) and Control group, each 52 cases, observed for 6 weeks. Plasma was measured by ELISA. PAI-1 and tPA were measured by chromogenic substrate method. Endogenous creatinine clearance (Ccr). Results The plasma Lp (a) levels of all the subjects were abnormally increased, the fibrinolytic function was inhibited, and Ccr was at a high level. Plasma Lp (a) decreased 6 weeks after treatment (P <0.05), plasma PAI activity decreased, tPA activity increased significantly improved fibrinolysis, Ccr decreased to normal. Conclusion Fluvastatin can down-regulate Lp (a), thereby improving fibrinolytic function, relieving glomerular hyperfiltration state and exerting renal protective effect.