| Objective:To investigate the effects of Prostaglandin E1(PGE1)in improving Proteinuria,Albuminuria and renal hemodynamics in type 2 diabetes with diabetic nephropathy.Analyse the relationship of vascular endothelial growth factor(VEGF) and transforming growth factor betal(TGF-β1)and the serious level of diabetic nephropathy.To observe the changes of the two factors after therapy.Methods:360 type 2 diabetes patients(male:186,female:174,age:39-74years old, average:57 years old,course of disease:2-20 years)were enrolled from Shandong Province Hospital from July,2005 to July,2007.All the patients were diagnosed as diabetes.The diagnosis of DN accord with that of Mogensen.1.240 diabetic patients were divided into four groups(stageⅢ,earlier stageⅣ,later stageⅣ,stageⅤ)and give them four treatment vegimens:conventional therapy,PGE1,PGE1+ACEI and ACEI. Proteinuria,albuminuria and creatinine were measured before and after treatmenting.They were been measured again after 3 months and 6 months.2.The rest were also divided into two groups and give them two treatment plans:one is conventional therapy and the other is conventional therapy and PGE1.Determine the blood flow of renal artery in patients with type 2 diabetes melilitus were checked by Doppler color flow imaging before and after treatmenting.Plasma VEGF and TGF-β1 levels were measured with ELISA.Results:1.the Change of Proteinuria In patients with diabetic nephropathy(ⅢandⅣ),the proteinuria and albuminuria descended markedly in PGE1 group and PGE1+ACEI group after 15 days,3 months and 6 months(P＜0.01).In patients with diabetic nephropathy(Ⅴ),the proteinuria and albuminuria descended markedly in PGE1 group and PGE1+ACEI group after 15 days,3 months(P＜0.05).But there was no significant change in ACEI group(P＞0.05).The two cytokines were discreaed in the conventional therapy group(P＜0.05).2.the Change of Renal hemodynamics In patients with diabetic nephropathy(ⅢandⅣ),the Vsmax Vdmin and Q of are significantly higher in PGE1 group than in conventional group(P＜0.01).The RI is lower in PGE1 group(P＜0.01).In patients with diabetic nephropathy(Ⅴ),the Vsmax Vdmin and Q of are significantly higher in PGE1 group(P＜0.05),The RI is lower in PGE1 group(P＜0.05).3.the Change of VEGF and TGF-β1 The levels of VEGF and TGF-β1 went up in patients with diabetic nephropathy(P＜0.01).In patients with diabetic nephropathy(ⅢandⅣ),the levels of VEGF and TGF-β1 descended more markedly in PGE1 group after treatment than in conventional group(P＜0.01).In patients with diabetic nephropathy(Ⅴ),the levels of VEGF and TGF-β1 were not changed in conventional group(P＞0.05),but descended markedly in PGE1 group(P＜0.05).Conclusion:1.The curative effect of PGE1 is patency.PGE1+ACEI is the best.Both PGE1 alone and PGE1+ACEI are better than ACEI alone in our 6 months study.2.PGE1 can improve renal hemodynamics remarkably..3.The levels of VEGF and TGF-β1 went up when diabetic nephropathy and descended when it went better.It suggested that VEGF and TGF-β1 were corelated to sevetity and therapy effect.These two factors maybe played an impotant part of development of diabetic nephropathy.4.Early treatment of nephropathy will get a better improvement.In patients with stageⅤnephropathy,it is hard to improve it.5.Longer followup is in progress.We will get a better understanding at 1 year's followup study.
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