The Effect Of α-lipoic Acid On Serum TNFR1 And Urinary PCX Excretion In Patients With Type 2 Diabetic Nephropathy

Objective:1. Set up a health control group, T2 DM with normal albuminuria group, T2 DM patients with microalbuminuria group and T2 DM with macroalbuminuria group, each group of TNFR1 in serum, urinary PCX, serum malondialdehyde(MDA), superoxide dismutase(SOD) and estimated glomerular filtration rate(e GFR) were observed. We also observed the correlation between the serum levels of TNFR1 and e GFR, urinary PCX and urinary albumin in the T2 DM group.2. The changes of the above indexes were observed after the intervention of the two groups of T2 DM with microalbuminuria group and macroalbuminuria group by α-lipoic acid.Methods:Ninety diabetic patients in type 2 from October 2014 to December 2015 obtained from the Department of endocrinology of Shanxi People’s Hospital outpatient and inpatient,according to urinary albumin/creatinine(ACR<30mg/g, 30-300 mg/g, > 300 mg/g) points to normal albuminuria group(30 cases), microalbuminuria group(30 cases) and macroalbuminuria group(30 cases), and the other to take health examination were 30 cases as normal control group, the microalbuminuria group and macroalbuminuria patients received the treatment of oral α-lipoic acid 600 mg daily, 12 weeks. Diabetic patients in each group were given diabetes health education, diet control, exercise therapy; the oral hypoglycemic agents or subcutaneous injection of insulin hypoglycemic routine treatment,blood glucose control is stable, while avoiding hypoglycemia. With hypertension were given antihypertensive drugs besides ACEI or ARB outside, make blood pressure below140/80 mm Hg. For patients with hematuria specimens, using enzyme-linked immunosorbent assay(ELISA) serum TNFR1, urinary PCX and oxidative stress indexes of serum superoxide dismutase(SOD), serum malondialdehyde(MDA) changes.Results:1.(1) Compared with the NC group, T2 DM group serum TNFR1, urinary PCX, MDA increased with the increasion in urinary albumin excretion, SOD decreased, e GFR decreased in MIA group and MAA group, the difference is statistically significant(P<0.05), e GFR in NA group compared with NA group did not change significantly, the difference was not statistically significant(P>0.05)(2) Serum TNFR1 was positively correlated with urinary PCX, ACR, MDA(ru=0.783,r A=0.775,rm=0.894, P<0.05), and negatively correlated with e GFR and SOD(re=- 0.873,rs=- 0.883, P<0.05);(3) Urinary PCX was positively correlated with ACR, MDA( ra=0.868, rm=0.819,P<0.05)was negatively correlated with SOD, e GFR(rs=-0.935, re=-0.761, P<0.05).2. After the treatment of α-Lipoic acid in microalbuminuria group serum TNFR1,urinary PCX, MDA reduced, e GFR and SOD increased, the difference is statistically significant(P<0.05), in macroalbuminuria patients oxidation stress index, serum TNFR1 have been improved(P<0.05), but urinary PCX, ACR, EGFR without significantly improved, the difference was not statistically significant(P>0.05);Conclusions:1. The concentration of serum TNFR1 in patients with type 2 diabetic nephropathy increased is related to the declination of e GFR;2. Patients with type 2 diabetic nephropathy PCX excretion rate increasing with the increased rate of urinary protein excretion;3. After the anti oxidative stress treatment with α-lipoic acid, the concentration ofserum TNFR1 and urinary PCX excretion in patients with DN reduced, and e GFR in microalbuminuria group was improved.