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目的观察吡格列酮对2型糖尿病(T2DM)患者尿转化生长因子β_1(TGF-β_1)排泄的影响,探讨其肾脏保护作用及机制。方法 98例血糖控制欠佳的T2DM患者随机分为联合吡格列酮(DP组)和磺酰脲类(DS组),治疗12周。检测治疗前后FPG、HbA_1c、尿白蛋白(UAlb)、肌酐(Cr)和TGF-β_1水平。结果 (1)治疗后,两组患者FPG、HbA_1c和尿TGF-β_1/Cr比值均显著降低,差异均有统计学意义。DP组UAlb/Cr比值(UAER)显著降低(P<0.01);DS组UAER轻度降低,差异无统计学意义。(2)治疗后两组间FPG和HbA_1c比较,差异无统计学意义。与DS组治疗后比较,DP组治疗后UAER和TGF-β_1/Cr值显著降低(P<0.05)。(3)尿TGF-β_1/Cr值与UAER显著正相关(r=0.367,P<0.01)。结论吡格列酮可减少T2DM患者UAlb和TGF-β_1排泄,其肾脏保护作用可能与其抑制体内TGF-β_1表达和排泄有关。
Objective To observe the effect of pioglitazone on excretion of urinary TGF-β1 in type 2 diabetes mellitus (T2DM) patients and to explore its renal protective effect and mechanism. Methods A total of 98 patients with T2DM with poor glycemic control were randomly divided into combined pioglitazone (DP group) and sulfonylureas (DS group) for 12 weeks. The levels of FPG, HbA 1c, UAb, Cr and TGF-β 1 were measured before and after treatment. Results (1) After treatment, the ratio of FPG, HbA 1c and urinary TGF-β 1 / Cr were significantly decreased in both groups, the differences were statistically significant. The UAb / Cr ratio (UAER) in DP group decreased significantly (P <0.01). UAER in DS group decreased slightly with no significant difference. (2) There was no significant difference in FPG and HbA 1c between the two groups after treatment. Compared with the DS group, the levels of UAER and TGF-β 1 / Cr in DP group were significantly decreased (P <0.05). (3) There was a significant positive correlation between urinary TGF-β_1 / Cr and UAER (r = 0.367, P <0.01). Conclusion Pioglitazone can reduce the excretion of UAlb and TGF-β 1 in T2DM patients, and its protective effect may be related to the inhibition of TGF-β 1 expression and excretion in vivo.