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目的对糖尿病患者早期肾损害进行评估,探讨左卡尼汀对2型糖尿病肾病(DN)患者微炎症状态的影响。方法选择北京昌平区医院2010年1月—2013年12月收治入院的早期DN患者200例,随机分为两组,每组100例。两组患者均采用常规标准饮食、运动量等常规治疗,对高血压患者采用钙离子拮抗剂(CCB)控制血压,观察组在常规治疗基础上静注左卡尼汀。观察两组患者治疗前后24 h尿蛋白定量、血清肌酐(Cr)、血清尿素氮(BUN)、血浆C反应蛋白(CRP)、血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等水平的改变。结果与同组治疗前比较,观察组治疗后CRP、IL-1、IL-6、TNF-α水平明显下降(P<0.05);与对照组治疗后比较,观察组治疗后CRP、IL-6、TNF-α水平下降明显(P<0.05),IL-1水平组间差异无统计学意义(P>0.05)。与同组治疗前比较,观察组在疗程结束后24 h尿蛋白定量、Cr、BUN水平明显下降(P<0.05);与对照组治疗后,观察组治疗后24 h尿蛋白定量、Cr水平下降明显(P<0.05),BUN水平组间差异无统计学意义(P>0.05)。结论左卡尼汀能够改善早期DN患者存在的微炎症状态,消除或控制促炎因素,延缓慢性肾脏病的发生、发展。
Objective To evaluate the effect of levocarnitine on the microinflammatory state in patients with type 2 diabetic nephropathy (DN). Methods 200 patients with early DN admitted to Changping District Hospital in Beijing from January 2010 to December 2013 were randomly divided into two groups (n = 100 in each group). The patients in both groups were treated by conventional standard diet and physical activity. The blood pressure was controlled by calcium channel blocker (CCB) in hypertensive patients. The observation group was given L-carnitine intravenously on the basis of routine treatment. The levels of urinary protein, serum creatinine (Cr), serum urea nitrogen (BUN), plasma C-reactive protein (CRP), serum interleukin-1 (IL-1), interleukin- (IL-6), tumor necrosis factor-α (TNF-α) and other levels of change. Results Compared with those before treatment, the levels of CRP, IL-1, IL-6 and TNF-α in the observation group were significantly decreased (P <0.05). Compared with the control group, the levels of CRP, IL- , TNF-α levels decreased significantly (P <0.05), IL-1 levels between the two groups showed no significant difference (P> 0.05). Compared with the same group before treatment, urinary protein and Cr, BUN levels in observation group decreased significantly 24 h after treatment (P <0.05). After treatment, the urinary protein and Cr level in observation group decreased 24 h after treatment (P <0.05), while there was no significant difference between BUN levels (P> 0.05). Conclusion L-carnitine can improve the microinflammatory state in patients with early DN, eliminate or control the pro-inflammatory factors and delay the occurrence and development of chronic kidney disease.