本文選題：2型糖尿病腎病 + 腫瘤壞死因子樣凋亡微弱誘導(dǎo)劑��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景與目的糖尿病腎病(Diabetic Nephropathy,DN)是常見的糖尿病(diabetes mellitus,DM)微循環(huán)受損的慢性并發(fā)癥之一。據(jù)統(tǒng)計(jì)慢性腎臟病(chronic kidney disease,CKD)的主要病因就是DN,而且已經(jīng)成為全球多數(shù)國(guó)家的終末期腎病(end-stage renal disease,ESRD)需要進(jìn)一步透析治療的首要病因。因此研究DN發(fā)病的機(jī)制及其治療具有相當(dāng)重要的意義。本研究通過觀察銀杏葉提取物注射液聯(lián)合纈沙坦對(duì)2型糖尿病腎病血清腫瘤壞死因子樣凋亡微弱誘導(dǎo)劑(sTWEAK),中性粒細(xì)胞與淋巴細(xì)胞的比值(NLR),血清IL-8的水平的變化,及評(píng)價(jià)銀杏葉提取物聯(lián)合纈沙坦治療效果,探討其對(duì)腎臟保護(hù)作用及可能機(jī)制。方法選取124例血清肌酐水平正常的2型糖尿病患者,根據(jù)Mogensen分級(jí)標(biāo)準(zhǔn)分為:單純2型糖尿病組34例(T2DM組),微量白蛋白尿組患者46例(MAU組),大量白蛋白尿組患者44例(Ma AU組),并選取同時(shí)期的30例健康人群作為健康組(NC組),比較各組間sTWEAK、NLR和IL-8的差異;之后,MAU組和Ma AU組隨機(jī)分為對(duì)照組和治療組,對(duì)照組患者以常規(guī)治療方案,包括控制飲食、適當(dāng)運(yùn)動(dòng)、胰島素降糖,并口服纈沙坦80mg/d治療;治療組患者在對(duì)照組的基礎(chǔ)上,應(yīng)用銀杏葉提取物注射液20ml靜滴QD,療程3周,在治療前后,比較sTWEAK、NLR和IL-8的水平并觀察各組治療效果。結(jié)果1.NC組、T2DM組、MAU組和Ma AU組IL-8、NLR水平逐漸升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.001);sTWEAK水平逐漸降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。2.采用二元logistics回歸,分別對(duì)影響2型糖尿病是否出現(xiàn)微量白蛋白尿和大量白蛋白尿的因素進(jìn)行探討。得知NLR和IL-8均為2型糖尿病出現(xiàn)微量白蛋白尿和大量白蛋白尿的獨(dú)立危險(xiǎn)因素,而血清sTWEAK為保護(hù)性因素。3.2型糖尿病腎病組中(MAU組和Ma AU組)IL-8、NLR、MAL(24小時(shí)尿微量蛋白)水平均呈正相關(guān)關(guān)系,而sTWEAK與上述因子呈負(fù)相關(guān)關(guān)系。4.治療后,MAU組Ma AU組中血清IL-8、NLR、MAL的水平均明顯降(P0.05),sTWEAK水平增高(P0.05);治療組患者治療后的MAL、IL-8、NLR的水平明顯低于對(duì)照組治療后的水平(p均0.05),sTWEAK明顯高于對(duì)照組治療后的水平(p0.05)。5.不論在MAU組還是Ma AU組,治療組的總體有效率均高于對(duì)照組。結(jié)論血清sTWEAK,NLR,IL-8可作為2型糖尿病腎病腎損傷的敏感指標(biāo),對(duì)評(píng)估2型糖尿病腎病的發(fā)生和病情的進(jìn)一步發(fā)展有重要意義;銀杏葉提取物注射液聯(lián)合纈沙坦具有保護(hù)腎臟作用,可能通過對(duì)微炎癥的抑制作用從而治療2型糖尿病腎病有良好的效果。
[Abstract]:Background & objective Diabetic Nephropathyne (DN) is one of the common chronic complications of diabetic diabetes mellitus (DM) with impaired microcirculation. According to statistics, the main cause of chronic kidney disease is DNs, and it has become the primary cause of end-stage renal disease (ESRD) in most countries in the world. Therefore, it is of great significance to study the pathogenesis and treatment of DN. The aim of this study was to observe the effects of ginkgo biloba extract injection combined with valsartan on serum tumor necrosis factor-like apoptosis (TNF-like), the ratio of neutrophils to lymphocytes and the level of serum IL-8 in type 2 diabetic nephropathy. To evaluate the therapeutic effect of Ginkgo biloba extract combined with valsartan and to explore its protective effect on kidney and its possible mechanism. Methods 124 patients with type 2 diabetes with normal serum creatinine levels were selected. According to the Mogensen classification standard, 34 patients with type 2 diabetes mellitus, 46 patients with microalbuminuria and 44 patients with large albuminuria were divided into three groups: 34 patients with type 2 diabetes mellitus, 46 patients with microalbuminuria and 44 patients with large amount of albuminuria. 30 healthy people of the same period were selected as the healthy group. The NLR and IL-8 of sTWEAKN were compared among different groups. Then the Mau group and MaAU group were randomly divided into two groups: the control group and the treatment group. The patients in the control group were treated with routine treatment, including diet control, proper exercise, insulin hypoglycemia, and oral valsartan 80mg/d treatment, and the patients in the treatment group were treated with valsartan 80mg/d on the basis of the control group. Ginkgo biloba extract injection 20ml was administered intravenously for 3 weeks. Before and after treatment, the levels of sTWEAKN NLR and IL-8 were compared and the therapeutic effects were observed. Results the levels of IL-8 NLR in 1.NC group were gradually increased, and the difference was statistically significant (P 0.001). The difference was statistically significant (P 0.001) and the difference was statistically significant (P 0.001) .2The results showed that the level of IL-8NLR in 1.NC group was higher than that in Mau group and Ma AU group, and the difference was statistically significant (P 0.001). The factors influencing microalbuminuria and large amount of albuminuria in type 2 diabetes mellitus were studied by binary logistics regression. Both NLR and IL-8 were independent risk factors for microalbuminuria and large albuminuria in type 2 diabetes. Serum sTWEAK was a protective factor in type 3.2 diabetic nephropathy group. The levels of IL-8 / NLRL in 24 hours urine microprotein in Mau group and Ma AU group were positively correlated, while sTWEAK was negatively correlated with the above factors. After treatment, the levels of serum IL-8 and NLRREAL in Ma AU group were significantly lower than those in the control group (P 0.05), and the levels of Mal IL-8 / NLR in the treatment group were significantly lower than those in the control group (P < 0.05) and the levels after treatment were significantly higher than those in the control group (P < 0.05). The total effective rate of the treatment group was higher than that of the control group both in MAU group and Ma AU group. Conclusion Serum sTWEAKN NLRR- IL-8 can be used as a sensitive index of renal injury in type 2 diabetes mellitus, and it is of great significance to evaluate the occurrence and further development of type 2 diabetic nephropathy, and that ginkgo biloba extract injection combined with valsartan can protect the kidney. It may have a good effect on type 2 diabetic nephropathy by inhibiting microinflammation.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R692.9

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