探讨硫辛酸联合缬沙坦对早期糖尿病肾病患者氧化应激及炎症水平的影响。

收集潍坊市人民医院2016年12月至2017年6月入院的128例早期糖尿病肾病患者，按入院时间随机分为4组。对照组患者给予常规治疗，实验组3组患者分别加用硫辛酸静脉滴注、缬沙坦口服及硫辛酸联合缬沙坦治疗，比较4组患者治疗前后糖代谢、尿蛋白水平、氧化应激水平及炎症水平，治疗前后比较采用配对样本t检验，组间比较首先进行方差分析，再采用LSD-t检验分别进行组间的两两比较。

硫辛酸组、缬沙坦组及联合组患者治疗后尿白蛋白、尿白蛋白/尿肌酐、丙二醛（MDA）、超敏C反应蛋白（hs-CRP）、8-异前列腺素F2α（8-iso-PGF2α）水平组间比较低于对照组[（20.36±4.32）mg/L vs （23.35±5.38）mg/L vs （16.48±3.37）mg/L vs （44.57±7.78）mg/L；（42.13±21.52）mg/g vs （45.78±16.47）mg/g vs （34.62±23.58）mg/g vs （74.72±15.33）mg/g；（4.71±0.78）mol/ml vs （5.17±0.84）mol/ml vs （3.87±1.31）mol/ml vs （5.96±0.96）mol/ml；（2.24±0.98）mg/L vs （2.35±1.17）mg/L vs （1.76±1.26）mg/L vs （2.93±1.15）mg/L；（34.98±6.51）ng/L vs （36.78±9.46）ng/L vs （30.19±13.25）ng/L vs （44.38±12.27）ng/L]，差异具有统计学意义（t=19.815、17.373、22.992，P均<0.001；t=10.029、8.906、12.026，P均<0.001；t=6.514、4.128、10.848，P均<0.001；t=5.769、4.999、7.721，P均<0.001；t=4.004、3.238、6.043，P<0.001、=0.001、<0.001）；超氧化物歧化酶（SOD）水平高于对照组[（78.62±5.31）U/ml vs （75.28±9.24）U/ml vs （83.31±6.18）U/ml vs （72.13±7.35）U/ml]，差异具有统计学意义（t=4.879、2.365、8.412，P<0.001、=0.019、<0.001）。且缬沙坦联合硫辛酸组较单用缬沙坦组或单用硫辛酸组患者治疗后尿白蛋白、尿白蛋白/尿肌酐、MDA、hs-CRP、8-iso-PGF2α水平低、SOD水平高，差异具有统计学意义（t=3.177、5.619，P=0.002、<0.001；t=1.996、3.120，P=0.047、<0.001；t=4.333、6.719，P=0.002、<0.001；t=1.981、2.478，P=0.049、=0.007；t=2.039、2.806，P=0.043、=0.006；t=3.533、6.047，P=0.001、<0.001）。

硫辛酸联合缬沙坦治疗可以改善早期糖尿病肾病患者氧化应激及炎症状态，具有治疗指导意义。

To evaluate the effects of lipoic acid combined with valsartan on oxidative stress and inflammation in patients with early diabetic nephropathy.

A total of 128 patients with early diabetic nephropathy who were hospitalized at the People′s Hospital of Weifang from December 2016 to June 2017 were randomly divided into four groups according to their admission time: control group, lipoic acid group, valsartan group, and lipoic acid + valsartan group. All the groups were given routine treatment. The lipoic acid group, valsartan group, and lipoic acid + valsartan group were additionally given intravenous infusion of lipoic acid, oral valsartan, and lipoic acid plus valsartan, respectively. The levels of glucose metabolism, urinary protein, oxidative stress, and inflammation were compared between before and after treatment using paired samples t test, and between groups using LSD-t test.

After treatment, urinary albumin, urinary albumin/creatinine ratio, malondialdehyde (MDA), high sensitivity C-reactive protein (hs-CRP), and 8-iso-prostaglandin F2α (8-iso-PGF2α) were significantly lower in the lipoic acid group, valsartan group and lipoic acid + valsartan group than in the control group [(20.36±4.32) mg/L, (23.35±5.38) mg/L, (16.48±3.37) mg/L vs (44.57±7.78) mg/L, t=19.815, 17.373, 22.992, P<0.001 for all; (42.13±21.52) mg/g, (45.78±16.47) mg/g, (34.62±23.58) mg/g vs (74.72±15.33) mg/g, t=10.029, 8.906, 12.026, P<0.001 for all; (4.71±0.78) mol/ml, (5.17±0.84) mol/ml, (3.87±1.31) mol/ml vs (5.96±0.96) mol/ml, t=6.514, 4.128, 10.848, P<0.001 for all; (2.24±0.98) mg/L, (2.35±1.17) mg/L, (1.76±1.26) mg/L vs (2.93±1.15) mg/L, t=5.769, 4.999, 7.721, P<0.001 for all; (34.98±6.51) ng/L, (36.78±9.46) ng/L, (30.19±13.25) ng/L vs (44.38± 12.27) ng/L, P<0.001, =0.001, <0.001]. Superoxide dismutase (SOD) was significantly higher in all treatment groups than in the control group [(78.62±5.31) U/ml, (75.28±9.24) U/ml, (83.31±6.18) U/ml vs (72.13±7.35) U/ml, t=4.879, 2.365, 8.412, P<0.001, =0.019, <0.001]. Urinary albumin, urinary albumin/creatinine ratio, MDA, hs-CRP, and 8-iso-PGF2α in the combination group were significantly higher than those in patients treated with valsartan or lipoic acid alone (t=3.177, 5.619, P=0.002, <0.001; t=1.996, 3.120, P=0.047, <0.001; t=4.333, 6.719, P=0.002, <0.001; t=1.981, 2.478, P=0.049, =0.007; t=2.039, 2.806, P=0.043, =0.006; t=3.533, 6.047, P=0.001, <0.001).

Lipoic acid combined with valsartan can improve the oxidative stress and inflammatory state in patients with early diabetic nephropathy.