·糖尿病肾脏疾病·

　　【摘要】 目的 观察α-硫辛酸(ALA)对T2DM患者氧化应激(OS)的影响及与肾小球足细胞标志蛋白排泄的关系，了解其对肾小球足细胞的保护及机制。 方法 选择T2DM患者36例作为实验组，于原糖尿病治疗的基础上加用ALA，另选择同期健康体检者30名作为对照(NC)组。6个月后，观察治疗前后FPG、HbA1c、血清还原型谷胱甘肽(GSH-Px)、超氧化物歧化酶(SOD)活性及尿丙二醛(MDA)、白蛋白(ALB)、Podocalyxin和Cr排泄的变化。 结果 (1)与NC组比较，实验组血清GSH-Px、SOD活性降低[(361.27±56.64) vs (521.26±57.02) U/ml,(56.94±9.75) vs (81.21±12.56) U/ml, P<0.01]，尿UMCR(UMDA/Ucr)、UACR(UALB/Ucr)及UPCR(UPCX/Ucr)值升高[(5.17±0.83) vs (3.09±0.65) nmol/(L·Cr), (52.65±29.56) vs (8.97±3.98) mg/(g·Cr), (42.37±9.80) vs (4.61±2.96) ng/(ml·Cr), P<0.01];(2)实验组经ALA治疗后，血清GSH-Px、SOD活性较治疗前升高[(401.87±71.06) vs (361.27±56.64) U/ml, (64.04±9.30) vs (56.94±9.75) U/ml, P<0.05)]，UMCR、UACR及UPCR降低[(3.91±0.57) vs (5.17±0.83) nmol/(L·Cr), (26.77±21.46) vs (52.65±29.56) mg/(g·Cr), (24.67±7.72) vs (42.37±9.80) ng/(ml·Cr), P<0.01)];(3) UPCR 与UACR、UMCR水平呈正相关(r=0.720、0.661,P<0.01),与血清GSH-Px、SOD水平呈负相关(r=-0.608、-0.559，P<0.01)。 结论 α-硫辛酸对T2DM患者肾小球足细胞有一定的保护作用，该作用可能与其减轻体内OS部分有关。

　　【关键词】 糖尿病慢性肾脏疾病;Podocalyxin;氧化应激; α-硫辛酸

　　【Abstract】 Objective To observe the effects of Alpha-lipoic acid(ALA) on oxidative stress(OS) in Vivo and urinary podocalyxin (glomerular podocyte marker protein) excretion in type 2 diabetics and its possible protective mechanisms glomerular on podocytes. Methods 36 patients with T2DM were recruited as the experiment group and treated with ALA on the basis of initial therapy. 30 healthy subjects at the same period were selected as the normal control (NC) group. At the basal and the 6 month after ALA treatment, FPG, HbA1c, serum glutathione peroxidase(GSH-Px), superoxide dismutase(SOD) activity, urinary malondialdehyde (MDA),urinary albumin(ALB) ,urinary podocalyxin(PCX) and urinary creatinine (Cr) were determined, respectively. Results (1) The serum GSH-Px and SOD was lower in experiment group than in NC group [(361.27±56.64) vs (521.26±57.02) U/ml,(56.94±9.75) vs (81.21±12.56) U/ml, P<0.01], but the urinary UMCR(UMDA/Ucr), UACR(UALB/Ucr) and UPCR(UPCX/Ucr) was higher [(5.17±0.83) vs (3.09±0.65) nmol/(L·Cr), (52.65±29.56) vs (8.97±3.98) mg/(g·Cr), (42.37±9.80) vs (4.61±2.96) ng/(ml·Cr), P<0.01]; (2) Serum GSH-Px, SOD increased significantly in experiment group After 6 months ALA treatment [(401.87±71.06) vs (361.27±56.64) U/ml, (64.04±9.30) vs (56.94±9.75) U/ml, P<0.05)], the levels of UMCR,UACR,UPCR reduced significantly [(3.91±0.57) vs (5.17±0.83) nmol/(L·Cr), (26.77±21.46) vs (52.65±29.56) mg/(g·Cr), (24.67±7.72) vs (42.37±9.80) ng/(ml·Cr), P<0.01)], but there was no significant changes in FPG and HbA1c;(3) UPCR was positive correlation with UACR and UMCR(r=0.720,0.661, P<0.01) ,and negative correlation with serum GSH-Px and SOD (r=-0.608,-0.559, P<0.01). Conclusion ALA can provide some protection for glomerular podocytes in type 2 diabetics , which maybe related partly to its effect in alleviating the enhanced OS in Vivo.

　　【Key words】 Chronic kidney disease in diabetes; Podocalyxin ; Oxidative stress ; Alpha-lipoic acid