Effects Of Pioglitazone On Serum Osteopontin And Urinary Microalbuminuria In The Type 2 Diabetic Patients With Diabetic Nephropathy

Objectives: 1 To investigate serum osteopontin(OPN) and c-reaction protein (CRP)in the type 2 diabetic patients with diabetic nephropathy.2 To investigate the effect of pioglitazone on serum OPN, CRP and urinary microalbuminuria in type 2 diabetic patients with diabetic nephropathy.Methods: 90 type 2 diabetes patients, between 30-70 years old, no less than 1 year course of disease, were divided into two groups randomly according to 2009diabetes nephropathy criteria of American Diabetes Association (ADA): diabetic nephropathy (DN n=60) and diabetes mellitus (DM n=30). Meanwhile, 30 healthy cases were selected for the Normal control (NC n=30). Then DN were randomly divided into two groups: placebo group(placebo combined with Insulin therapy, n=30) and pioglitazone group(Pioglitazone combined with Insulin therapy, n=30). Both of the groups were treated for 3 months. Before the treatment of all cases and after 3 months treatment of DN group checked and analyzed of body mass index (BMI),fasting plasma glucose(FPG), 2-hours postprandial blood glucose(2hPBG), glycated hemoglobin A_1c(HbA_1c), triglyceride(TG), total cholesterol (TC),low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), and blood urea nitrogen(BUN), serum creatinine (Scr), CRP , OPN, microalbumin-to-cre- atinine ratio (UMA/Cr).Results:1 Comparison on the levels of serum OPN and CRP among NC,DM and DN:1 Compared with NC,the levels of OPN in DM and DN were significanct increased, the difference was significant (99.20±20.90 vs269.90±66.70, 497.60±121.70ng.ml^-1P<0.01) The levels of OPN in the DN increased significant than that in the DM, the difference was significant. (269.90±66.70vs497.60±121.70ng.ml^-1,P<0.01). 2Compared with NC, the levels of CRP in DM and DN were significanct increased, the difference was significant (0.95±0.36 vs2.65±0.89, 2.84±1.01 mg.l^-1,P<0.05)Comparison on the it in DN and DM, the difference was not statistical significant (2.65±0.89 vs2.84±1.01mg.l^-1,P>0.05).2 The after treatment levels of OPN and CRP were lower than those before treatment in placebo group, but the difference was not statistical significant. Pioglitazone group decreased its significantly after treatment. After the treatment the level of OPN and CRP in the pioglitazone group were lower than those in the placebo group, the differences were significant (OPN: 394.20±19.43 vs 457.00±15.21ng.ml^-1,P<0.01.CRP: 2.38±0.77 vs 2.72±0.93 mg.l^-1, P<0.05).3 The after treatment level of UMA/Cr was lower than those before treatment in placebo group, but the difference was not statistical significant. Pioglitazone group decreased it significantly after treatment. After the treatment the levels of UMA/Cr in the pioglitazone group was lower than those in the placebo group, the difference was significant(35.00±6.38 vs 86.30±12.21 g.mg^-1 P<0.05).4 In the pioglitazone group took the UMA/Cr( :the difference between before and after treatment) as dependent variable and the OPN, CRP, FPG, 2hPBG, HbA_1c, TG, age, course of disease, sex as independent variables,the formulation involving OPN were calculated by multiple stepwise regression analysis.The formulation: UMA/Cr 45.908+0.201 OPN. The levels of UMA/Cr were correlated positively with OPN(r=0.673,P=0.000), CRP(r=0.517,P=0.003), FPG(r=0.397,P=0.022), HbA_1c (r=0.426,P=0.015) and TG(r=0.363,P=0.034).Conclusions:1 The levels of OPN and CRP are increase in type 2 diabetic patients with diabetic nephropathy.2 Pioglitazone can reduce the seurm OPN,CRP levels and inflammation,decrease urinary microalbuminuria of type 2 diabetic patients with diabetic nephropathy.