|
Objective:To explore the effects of low dose of spironolactone on the urinary 8-iso-prostaglandin F2a(8-iso-PGF2a) and the ratio of urine albumin to cretine(ALB/CR) in type 2 diabetic patients with early diabetic nephropathy.Methods:42 type 2 diabetic patients with the third stage of diabetic nephropathy were enrolled in and divided into treatment group (Group T, n=21) and control group (Group C, n=21) respectively. Patients in Group C were treated regularly, and Group T added spironolactone 20 mg daily for 12 weeks. Urinary 8-iso-PGF2α,urinary ALB/CR. serum creatinine (Scr) and glycolated hemoglobin A1c (HbA1c) were measured at the begin and the end of 12 weeks treatment. Urinary 8-iso-PGF2a was detected by enzymelinked immunosorbent assay (ELISA), urinary ALB by radioimmunoassay (RIA), urinary creatinine and Scr by picric acid method and HbAlc by high performance liquid chromatography (HPLC).Results:There were no significant differences between Group C and Group T in age, sex, course of disease, body mass index(BMI), urinary 8-iso-PGF2a, urinary ALB/CR, Scr and HbA1c (P> 0.05, respectively). (1) The level of urinary 8-iso-PGF2αin Group T (130.49±110.60pg/ml) was lower than that of Group C (450.03±401.29pg/ml) (t=3.5179, P=0.0011), samely, the Urinary ALB/CR in Group T (34.75±25.66 mg/g) was lower than Group C (121.96±115.30 mg/g) (t=3.3832, P=0.0016) after the treatment. There were no differences between the two groups in Scr and HbAlc (P>0.05). (2) The level of urinary 8-iso-PGF2αafter the treatment (130.49±110.60pg/ml) was lower than the begining (348.66±268.64pg/ml) (t=3.5653, P=0.0019), the urinary ALB/CR level after the treatment (34.75±25.66mg/g) was lower than the before (113.05±96.73mg/g) (t=3.6123,P=0.0017) samely. The levels of both the Scr and the HbA1c showed no difference between the end and the begin of the treatment (P>0.05, respectively) in Group T. (3) The level of urinary 8-iso-PGF2αafter the treatment (450.03±401.29pg/ml) was higher than the beginning(290.77 ±290.27pg/ml)(t=2.5836, P=0.0179), the urinary ALB/CR level after the treatment (121.96±115.31mg/g) was higher than the before (67.96±50.72mg/g) (t=2.9065, P=0.0088) samely, the levels of both the Scr and the HbAlc showed no difference between the end and the begin of the treatment(P>0.05, respectively) in Group C. (4) The average decrease of urine 8-iso-PGF2a level after the treatment in Group T (-142.57±204.18pg/ml) was different with that in Group C (104.13±300.10pg/ml)(t=3.1147, P=0.0034), in the same way, urine ALB/CR decrease (-78.30±99.35mg/g v.s.54.00±85.19mg/g, t=4.6325, P=0.0007). (5) The adverse effects such as hyperkalemia, hyponatremia and gynecomastia of spironolactone on the two Groups were not observed..Conclusions:Low dose of spironolactone can significantly reduce the levels of urine 8-iso-PGF2αand microalbuminuria in type 2 diabetes patients with early diabetic nephropathy. It may prevent the development of diabetic nephropathy.
|