血管紧张素Ⅱ1型受体拮抗剂对早期糖尿病肾病患者尿液中足细胞相关蛋白nephrin、自噬基因Beclin-1 mRNA排泄的影响

doi:10.3969/j.issn.1004-583X.2021.11.009

摘要/Abstract

摘要：

目的观察早期糖尿病肾病(diabetic nephropathy, DN)患者尿液中足细胞、足细胞相关蛋白nephrin、自噬基因Beclin-1 mRNA 排泄及氯沙坦对上述指标的影响。方法入选2018年1月-2021年1月我院确诊的符合标准的早期DN患者48 例,给予氯沙坦50 mg或100 mg口服6个月,观察治疗前后患者尿液中微量白蛋白、足细胞、足细胞相关蛋白nephrin mRNA、自噬基因Beclin-1 mRNA排泄。结果早期DN患者尿液中微量白蛋白排泄、足细胞及足细胞相关蛋白nephrin、自噬基因Beclin-1 mRNA排泄均较健康人明显增加(P<0.01)。给予氯沙坦治疗6个月后,与治疗前比较,患者尿液中微量白蛋白、足细胞排泄减少(P<0.05),nephrin mRNA排泄呈下降趋势(P<0.05),自噬基因Beclin-1 mRNA排泄较治疗前有一定增加,但差异无统计学意义(P=0.067)。结论早期DN患者可通过尿液检查证实存在足细胞损伤。血管紧张素Ⅱ1型受体拮抗剂可以减少DN患者尿微量白蛋白排泄,保护足细胞,并可能增强足细胞自噬作用。

关键词: 糖尿病肾病, 血管紧张素Ⅱ1型受体拮抗剂, 足细胞

Abstract:

Objective To observe the urinary excretion of podocytes, podocyte-related protein nephrin and autophay gene Beclin-1 mRNA of patients with early diabetic nephropathy(DN) and the effects of Losartan on the above indicators.Methods Forty-eight cases of early DN patients in our hospital from January 2018 to January 2021 were selected and given Losartan 50 mg or 100 mg orally for 6 months. The urine of early DN patients was sampled to determine the excretion of microalbumin, podocytes, podocyte-related protein nephrin mRNA, and autophagy gene Beclin-1 mRNA before and after treatment.Results The urinary excretion of microalbumin, podocyte, podocyte-related protein nephrin, autophagy gene Beclin-1 mRNA of early DN patients were significantly increased compared with healthy people (P<0.01). After six months of treatment with Losartan, urinary excretion of microalbumin and podocytes in patients with early DN decreased (P<0.05).The urinary excretion of nephrin mRNA showed a downward trend (P<0.05). The autophagy gene Beclin-1 mRNA excretion increased to a certain extent after treatment, but the difference was not statistically significant (P=0.067).Conclusion Podocyte damage can be confirmed by urine examination in patients with early DN.Angiotensin Ⅱ type 1 receptor blockers can reduce the excretion of microalbumin to protect podocytes and enhance podocyte autophagy in early ND patients.

Key words: diabetic nephropathy, angiotensin Ⅱ type 1 receptor blockers, podocyte

中图分类号:

R587.24

刘伦志, 邓璐, 张明霞. 血管紧张素Ⅱ1型受体拮抗剂对早期糖尿病肾病患者尿液中足细胞相关蛋白nephrin、自噬基因Beclin-1 mRNA排泄的影响[J]. 临床荟萃, 2021, 36(11): 1005-1008.

Liu Lunzhi, Deng Lu, Zhang Mingxia. Effects of angiotensin Ⅱ type 1 receptor blockers on urinary nephrin and Beclin-1 mRNA excretion in urine of patients with early diabetic nephropathy[J]. Clinical Focus, 2021, 36(11): 1005-1008.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.11.009

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I11/1005

图/表 5

参考文献 19

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组别	例数	空腹血糖 (mmol/L)	胆固醇 (mmol/L)	血浆白蛋白 (g/L)	血肌酐 (μmol/L)
对照组	30	4.95±0.85	3.95±0.92	42.26±9.72	78.63±14.46
DN组	48	6.33±1.20^*	4.87±1.12^*	40.01±6.12	79.44±15.40
t值		0.513	3.786	1.254	0.234
P值		0.000	0.000	0.214	0.815

组别	例数	空腹血糖 (mmol/L)	胆固醇 (mmol/L)	血浆白蛋白 (g/L)	血肌酐 (μmol/L)
对照组	30	4.95±0.85	3.95±0.92	42.26±9.72	78.63±14.46
DN组	48	6.33±1.20^*	4.87±1.12^*	40.01±6.12	79.44±15.40
t值		0.513	3.786	1.254	0.234
P值		0.000	0.000	0.214	0.815

检测时间	例数	空腹血糖 (mmol/L)	胆固醇 (mmol/L)	血浆白蛋白 (g/L)	血肌酐 (μmol/L)
治疗前	48	6.33±1.20	4.87±1.12	40.01±6.12	79.44±15.40
治疗后	48	6.13±1.23	4.68±1.18	39.98±3.46	77.04±14.18
t值		0.824	0.766	0.035	0.737
P值		0.414	0.448	0.972	0.465

检测时间	例数	空腹血糖 (mmol/L)	胆固醇 (mmol/L)	血浆白蛋白 (g/L)	血肌酐 (μmol/L)
治疗前	48	6.33±1.20	4.87±1.12	40.01±6.12	79.44±15.40
治疗后	48	6.13±1.23	4.68±1.18	39.98±3.46	77.04±14.18
t值		0.824	0.766	0.035	0.737
P值		0.414	0.448	0.972	0.465

组别	例数	足细胞排泄 (个/20个视野)	UACR (mg/g)
对照组	30	0.10±0.31	23.13±11.24
DN组	48	23.63±5.23	249.88±36.58
t值		5.160	32.957
P值		0.000	0.000