Levels Of Oxidative Stress Indexes In Different Stages Of Type 2 Diabetic Nephropathy And Effects Of Lipoic Acid On Treatment

Part Ⅰ Levels of oxidative stress indexes in different stages of type 2 diabetic nephropathyAims:To observe the changes in serum oxidative stress indexes at different stages in disease of patients with type 2 diabetic nephropthy and to find out association between oxidative stress indexes and progression of diabetic nephropathy.Methods:A total of ninety hospitalized patients with type 2 diabetes(T2DM)from Month 2016 to Month 2018 were selected for the study.According to the urinary albumin/creatinine(UACR),all patients with type 2 were divided into normal albuminuria(NA)group(30 cases)(UACR<30mg/g);micro albuminuria(MA)group(30 cases)(3 0mg/g<UACR<300mg/g);macro albuminuria/clinical albuminuria(CA)group(30 cases)(UACR>300mg/g).At the same time,30 cases of physical examinations in our hospital at the same time were randomly selected as the normal control group(NC).The normal albuminuria group included 14 male patients and 16 female patients;There were 18 male patients and 12 female patients in the micro proteinuria group;17 male patients and 13 female patients in the macro albuminuria group;while 14 male patients and 16 female patients in the normal control group.All patients had eGFR>30ml/(min*1.73m2).General case data of gender,age,height,weight and body mass index(BMI)in the four groups were recorded.Using enzyme-linked immunosorbent assay(ELISA)to detect serum malondialdehyde(MDA),superoxide dismutase(SOD),and interleukin 6(1L-6),also detect serum C-reactive Protein(CRP),serum creatinine(Scr)and UACR.According to the modified MDRD formula,the eGFR level was calculated.The eGFR formula is eGFR=175×(Scr,mg/dl)-1.234×(age)-0.179×(0.79female).Objective to evaluate the difference of oxidative stress indexes in different stages of diabetic nephropathy and the correlation between oxidative stress indexes and the progression of diabetic nephropathy.Results:1.There was no significant differences in age and BMI between the four groups(all P>0.05).2.MDA,1L-6,CRP,Scr,UCAR in the normal albuminuria group were significantly higher than those in the normal control group,while SOD was significantly lower(P<0.05).But there was no significant difference with eGFR between those two groups(P>0.05);In micro proteinuria group and macro proteinuria group,MDA,1L-6,CRP and UCAR were significantly higher than those in normal albuminuria group,while SOD and eGFR were significantly lower.Differences in learning(P<0.05);MDA,1L-6 and UCAR in macro proteinuria group were significantly higher than those in micro albuminuria group,SOD and eGFR were significantly lower than those in micro albuminuria group(all P<0.05).But Scr and CRP in micro albuminuria group and macro proteinuria group did not change either(P>0.05).3.In type 2 diabetes group,SOD was positively correlated with Scr,IL-6 and UACR,negatively correlated with eGFR(P<0.05);MAD was positively correlated with eGFR,negatively correlated with Scr,IL-6 and UACR(P<0.05).But CRP has nothing to do with either SOD or MAD(P>0.05).Conclusion:Through this study,we found that patients with type 2 diabetic nephropathy gradually aggravate as the disease progresses,oxidative stress level increased,IL-6 gradually increased,eGFR gradually decreased,but no significantly change of CRP.There was no significant difference in eGFR between normal albuminuria group and normal control group.These results suggest that oxidative stress levels increase with the occurrence and development of diabetic nephropathy,and may be related to inflammation.promote inflammation.These results provide clinical reference for early diagnosis and antioxidant therapy of diabetic nephropathy.Part Ⅱ Effect of lipoic acid on type 2 diabetic nephropathyAims:Evaluate the short-term clinical efficacy of lipoic acid in the treatment of type 2 diabetic nephropathy,and objectively evaluate the clinical efficacy of lipoic acid.The clinical mechanism and theory were used to explore its mechanism,also evaluate its efficacy and safety.Methods:Select a total of 60 patients with type 2 diabetic nephropathy from two groups in the first part of this study,micro albuminuria(MA)group(30 cases)(30mg/g<UACR<300mg/g)and macro albuminuria/clinical albuminuria(CA)group(30 cases)(UACR>300mg/g).All patients had eGFR>30ml/(min*1.73m2).The serum MDA,SOD,1L-6,CRP,Scr and UACR were detected before and after treatment with lipoic acid 600 mg(i.v.drip qd)for 2 weeks.the eGFR level was calculated before and after treatment,with the eGFR formula:eGFR=175×(Scr,mg/dl)-1.234×(age)-0.179×(0.79female).Evaluate the effect of lipoic acid on oxidative stress and inflammation by analyzing the changes of MDA,SOD,IL-6 and CRP before and after treatment in the two groups;evaluate the short-term therapeutic effect of lipoic acid on patients with diabetic nephropathy in different stages by analyzing the changes of renal damage index(UACR,eGFR)before and after treatment.Also evaluate of safety and feasibility and other complications and adverse reactions.Results:After lipoic acid treatment:the levels of MDA,UACR,IL-6,CRP in micro albuminuria group were all decreased,the levels of SOD and eGFR were increased,the differences were statistically significant(P<0.05);but Scr had no change(P>0.05).MDA,UACR,IL-6 in macro albuminuria group were decreased,SOD was increased(P<0.05);but there were no significant differences in Scr,CRP and eGFR(P>0.05).No adverse reactions and adverse events occurred in all groups.Conclusion:The results of this study showed that lipoic acid treatment of type 2 diabetic nephropathy has a good short-term clinical efficacy,including reduction in oxidative stress levels and urinary protein excretion,improvement of eGFR in early diabetic nephropathy.It may also participate in the inhibition of inflammation.Continuous intravenous drip for 2 weeks has a low incidence of adverse reactions,which provides a new direction for the treatment of type 2 diabetic nephropathy and has clinical value.