| Objective:A study was made to analyze the microalbuminuria influence of Pioglitazone to the diabetic nephrophthy (DN) patients. And we also analyze the relationship of the blood serum C-reactive protein (hs-CRP) and diabetic nephrophthy (DN) in severity. Observation was made about the change of C-reactive protein (hs-CRP) in blood serum after treated with Pioglitazone and the clinic sense was analysed. All the research has provided reliable theory for the treating of Diabetic Nephrophthy in the early stage.Methods: 90 patients diagnosised definitely with type 2 diabetes mellitus selected in No.1 hospital of Jining from September 2009 to October 2010.Where, the T2DM diagnosis was based on IDF diabetes mellitus diagnostic criteria and DN diagnosis was based on Mogensen diagnostic criteria.The patients were devided into three groups based on the UAER:①35patients (64.40±9.74) years old with NA (UAER<20μg/min )in which 18 men and 17women were included.②29 patients (62.48±9.66) years old with MA(UAER 20-200μg/min)in which 15men and 14women were included.③26 patients (62.08±9.57) years old with CP(UAER>200μg/min)in which 12 men and 14 women were included.30 patients were selected from healthy physical examinees with 14 men and 16 women (63.33±9.29) years old as the normal control group.1. At the baseline, basic clinical data of all subjects such as age, height, weight and blood pressure were collected; biochemical parameters such as fasting plasma glucose(FPG),glycated hemoglobin(HbAlC), lipids and creatinine(Cr)were measured; C-reactive protein(hs-CRP) and urinary albumin excretion rate(UAER) were tested by ELISA.2. The Microalbuminuria group and clinical proteinuria group were randomly divided into pioglitazone treatment group and the normal therapy group, which is the MA Pioglitazone treatment group, MA normal treatment group, CP Pioglitazone treatment group, CP normal treatment group. Then the change of hs- CRP, UAER levels were observed after 3 months treatment for each group.Results:1.The comparison of serum C-reactive protein(hs-CRP):①The hs-CRPs of NA, MA, CP rose significantly compared with NC and the differences had statistical senses (P<0.01) .②As to the comparison among the MA, CP and NA groups, the hs-CRP increased graduallyand the differences had statistical senses (P<0.01).③The hs-CRP differece between the group MA and group CP had great significance (P<0.01).2.The correlation between hs-CRP level and UAER,Cr,illness duration:①The correlation between hs-CRP level and UAER:The correlation analysis of blood hs-CRP and UAER concentration were done to the selected patients which the results were: They were positively associated with the Pearson correlation factor 0.896 , P<0.01.②The correlation between hs-CRP level and Cr:The correlation analysis of blood hs-CRP and Cr were done to the selected patients which the results were: They were positively associated with the Pearson correlation factor 0.799, P>0.05.③The relationship between the hs-CRP level and illness duration: hs-CRP increased with the process and with the correlation analysis , they were positively associated with the Pearson correlation factor 0.822,P<0.01.3.The change of hs-CRP and UAER:(1) The change of hs-CRP:①As to the group MA, the comparison results of hs-CRP before and after 3 months Pioglitazone treatment with the UAER decreased significantly (P<0.01). While the differences of hs-CRP with the normal treatment were not significant with the results (P>0.05). After the treatment, the hs-CRP of the group treated with Pioglitazone was lower than the control one and the differences were significant (P<0.01).②As to the group CP, the comparison results of hs-CRP before and after 3 months Pioglitazone treatment with the UAER decreased significantly (P<0.05). While the differences of UAER with the normal treatment were not significant (P>0.05). After the treatment, the hs-CRP of the group treated with Pioglitazone was lower than the control one and the differences were significant(P<0.01). (2)The change of UAER:①As to the group MA, the comparison results of UAER before and after 3 months Pioglitazone treatment with the UAER decreased significantly(P<0.01). While the differences of UAER with the normal treatment were not significant (P>0.05). After the treatment, the UAER of the group treated with Pioglitazone was lower than the control one and the differences were significant (P<0.01).②As to the group CP, the comparison results of UAER before and after 3 months Pioglitazone treatment with the UAER decreased significantly (P<0.01). While the differences of UAER with the normal treatment were not significant (P>0.05). After the treatment, the UAER of the group treated with Pioglitazone was lower than the control one and the differences were significant (P<0.01). 4. The comparison of curative effects for the MA group and CP group:①The UAER of MA group decreased about 58% after 6 months Pioglitazone treatment while 31% for CP group. As we can see, the UAER of MA group decreased significantly and the curative effect is better than the CP group(P<0.05).②The hs-CRP of MA group decreased about 40% after 3 months Pioglitazone treatment while 22% for CP group. As we can see, the hs-CRP of MA group decreased significantly and the curative effect is better than the CP group(P<0.05).Conclusions:1. hs-CRP, UAER, Cr and the process were positively correlated. Hs-CRP concentration and T2DM and the progress of nephropathy has the consistency to some degree which may play an important role in the pathogenesis of DN.2.Pioglitazone can decrease the hs-CRP level by anti-inflammatory effect and then decrease the UAER level in order to improve kidney function which plays in renal protection.3. The earlier the Diabetic Nephrophthy is treated, the better the curative effect will be. The curative effect is not good after clinical stage. |
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