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目的观察盐酸吡格列酮对2型糖尿病患者尿血管内皮生长因子(VEGF)排泄的影响,探讨其肾脏保护的可能机制。方法将98例血糖控制欠佳的2型糖尿病患者随机分为联合吡格列酮治疗组(DP组)和联合磺酰脲类药物治疗组(DS组)。12周后,观察治疗前后空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿白蛋白(ALB)、肌酐(Cr)及VEGF水平变化。结果①治疗12周后,DP组FBG、HbA1c、UACR(尿ALB浓度)及UVCR(尿VEGF浓度)较治疗前明显下降,差异有统计学意义(P<0.05);DS组FBG、HbA1c及UVCR值较治疗前明显下降,差异有统计学意义(P<0.05),UACR值轻度降低,差异无统计学意义(P>0.05)。②治疗后,两治疗组间FBG和HbA1c无明显差异,DP组UACR及UVCR较DS组明显降低,差异有统计学意义(P<0.05)。③尿UVCR水平与UACR呈显著正相关(r=0.643,P<0.01),与FBG、HbA1c无相关。结论吡格列酮可以减少2型糖尿病患者尿白蛋白及VEGF的排泄,其肾脏保护作用可能与其抑制体内VEGF过度表达和排泄,以及保护足细胞有关。
Objective To observe the effect of pioglitazone hydrochloride on the excretion of urinary vascular endothelial growth factor (VEGF) in type 2 diabetes mellitus (T2DM) patients and to explore the possible mechanism of renal protection. Methods A total of 98 type 2 diabetic patients with poor glycemic control were randomly divided into combined pioglitazone group (DP group) and combined sulfonylurea group (DS group). After 12 weeks, the changes of fasting blood glucose (FBG), HbA1c, ALB, creatinine (Cr) and VEGF levels were observed before and after treatment. Results ① After 12 weeks of treatment, FBG, HbA1c, UACR (urinary ALB) and UVCR (urinary VEGF) in DP group were significantly lower than those before treatment (P <0.05); FBG, HbA1c and UVCR (P <0.05), UACR decreased slightly, the difference was not statistically significant (P> 0.05). ② After treatment, there was no significant difference between FBG and HbA1c in the two treatment groups. UACR and UVCR in DP group were significantly lower than those in DS group, with significant difference (P <0.05). There was a significant positive correlation between urinary UVCR level and UACR (r = 0.643, P <0.01), but not with FBG and HbA1c. Conclusion Pioglitazone can reduce the excretion of urinary albumin and VEGF in patients with type 2 diabetes. Its renal protective effect may be related to the inhibition of VEGF overexpression and excretion in vivo and the protection of podocytes.