| Objective:Statins have been considered as effective lipid-lowering drugs,in recent years,with the further research on their mechanism,we find that they have cholesterol-independent pleiotropic effects,such as reducing inflammation,alleviating oxidative stress,modifying the immunologic responses,improving endothelial function and suppressing platelet aggregation.Some scholars at home and abroad have done a lot of things for the research of the micro inflammatory state in diabetic nephropathy and the effect of statins in patients with diabetic nephropathy by improving the micro inflammatory state,they found that patients with chronic kidney disease can exist micro inflammation state even in the early stage,and statins may reduce C-reaction protein in patients with chronic kidney disease,play a role in renal protection by improving the micro inflammatory state in the body.Otherwise there are also some studies show that statins can reduce the urine protein level in patients with chronic kidney disease.Therefore,the role of statins in protecting kidney and reducing proteinuria are getting more and more attention.But at present,there still little research on micro inflammation state and specific therapeutic effects of statins in patients with diabetic nephropathy.This study aims to observe the micro inflammatory state,and statins' cholesterollowering and cholesterol-independent renoproductive effects and the effect of reducing urinary protein based on reducing blood lipid and improving micro inflammatory state in patients with ?-? diabetic nephropathy.And to study the safety of statin application in patients with diabetic nephropathy in ?-? phase.Methods:We selected 60 patients with diabetic nephropathy in stage ?-?,who were hospitalized and diagnosed as diabetic nephropathy in ?-? phase in the Department of Nephrology and Department of endocrinology of the Third Clinical College of Jilin University during October 1,2014 to May 31,2016.Their clinical pathological data were retrospectively recruited.The patients were randomly divided into the control group and the experimental group.There are 29 cases in the control group and 31 cases in the experimental group.The control group received routine treatment(low salt,low fat,low protein,high quality protein,diabetic diet,proper exercise,control of blood glucose and blood pressure,improve blood circulation,protect renal function.And maintain the blood pressure in the range of 110-135/70-85 mm Hg,maintain the blood glucose in the range of 4.4-7.5mmol/L).In addition to the conventional therapy,we give patients who were in the experimental group atorvastatin calcium(20mg,oral administration,before bedtime).According to the treatment,we can adjust the drug dosage,but the maximum dose should not exceed 40mg/d.1?Collect serum lipids(total cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol),inflammatory markers(C-reactive protein),renal function(serum creatinine,urea nitrogen)and the baseline level of 24 h urine protein quantitative analysis of the two groups before treatment and evaluate the difference between the two groups;2?To analyze the correlation between CRP and the corresponding 24 h urine protein and renal function indexes(Scr,BUN)before treatment;3?Collect the above index of the two groups of patients after 4 weeks and 16 weeks after treatment,evaluate the difference of the index before and after treatment in each group.And compare the difference of the index between the two groups after treatment for 4 weeks and 16 weeks respectively;4?Collect the adverse reaction type and frequency of the two groups of patients during treatment.Results:1?There is no Statistical differences in sex?age ?serum lipid index,inflammation index,renal function index and 24 h urinary protein between the experimental group and the control group(P > 0.05);2?Pearson correlation analysis of the overall sample: CRP and 24 h urinary protein(r=0,790,P < 0.001)?BUN(r=0.846,P < 0.001)?Scr(r=0.866,P < 0.001)have significant positive correlation;3 ?After 4 weeks of treatment with different scheme,TG,LDL-C,CHOL,CRP,Scr,BUN,24 h urinary protein were decreased,HDL-C increased,but the changes in these indicators were more significant in experimental group.The above indexes after treatment have significantly statistical differences compared with indexes before treatment(P < 0.05);4?After 16 weeks of treatment,CHOL,TG CRP,BUN,LDL-C,Scr,24 h,urinary protein were decreased and HDL-C was increased compared with that after 4 weeks of treatment.The above indexes after 16 weeks of treatment have significantly statistical differences compared with indexes after 4 weeks of treatment(P < 0.05);5?After 4 weeks and 16 weeks treatment of different schemes,CHOL,TG,LDL-C,CRP,BUN,Scr,24 h urinary protein decreased and HDL-C increased more significantly in the experimental group.The above indexes from the experimental group have significantly statistical differences compared with indexes come from the control group(P < 0.05);6 ? Analysis of the adverse reactions of two groups: the control group had no adverse reaction.There is 1case of test group appeared nausea,no vomiting,and the symptom is mild.After giving Symptomatic treatment to protect the stomach,the symptom of nausea relieved significantly.In addition,there is 1 case who have a mild elevation of hepatic transaminases.We consider that the mild elevation of hepatic transaminases might be caused by the large drug dose.After adjusting the dosage and treatment of protecting liver,the hepatic transaminases returned to be normal.There were no adverse reactions such as headache?rash?angioneurotic edema?severe muscle damage and severe liver damage.Conclusion:1 ? In patients with stage ?-? diabetic nephropathy,there exists a micro inflammatory state universally.CRP has been able to detect the presence of inflammation.CRP was positively correlated with micro inflammatory status and the severity of kidney disease.2?Atorvastatin can reduce CRP in circulation.And it can improve the micro inflammatory state in patients with diabetic nephropathy in ?-? phase.The anti-inflammatory effect depends not only on the improvement of the inflammatory caused by dyslipidemia,more important is that it can play an important role in the inflammation which exists in diabetic nephropathy.3 ? Atorvastatin has protective effect on kidney in patients with stage ?-? diabetic nephropathy and can reduce the urinary protein level.This role depends not only on lipid-lowering,but also on another more important aspect:the cholesterol-independent renoproductive effect(anti-inflammatory,micro inflammatory state).4?Atorvastatin has less adverse reaction in patients with stage ?-? diabetic nephropathy,and has excellent safety. |
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