Cooper Mark E, Jandeleit-Dahm Karin A M
JDRF Danielle Alberti Memorial Centre for Diabetic Complications, Vascular Division - Wynn Domain, Baker Heart Research Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia.
Curr Diab Rep. 2005 Dec;5(6):445-8. doi: 10.1007/s11892-005-0053-9.
Diabetic nephropathy is commonly associated with dyslipidemia, but the role of lipids in the progression of this disorder remains unresolved. In particular, the role of lipid-lowering drugs, such as 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors and fibrates, as renoprotective agents is not clarified. Experimental studies have demonstrated that dietary lipids promote renal injury and that statins, independent of their lipid-lowering effects, confer renoprotection via effects on intrarenal hemodynamics and renal cytokine and chemokine expression. Clinical studies have in general been underpowered, but a recent meta-analysis and findings from the Heart Protection Study suggest that statins may be renoprotective. Nevertheless, with the convincing antiatherosclerotic effects of these agents, including in the setting of diabetes, they should be widely administered in the diabetic population with or at risk for nephropathy.
糖尿病肾病通常与血脂异常相关，但脂质在这种疾病进展中的作用仍未明确。特别是，降脂药物，如3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂和贝特类药物作为肾脏保护剂的作用尚未阐明。实验研究表明，饮食中的脂质会促进肾脏损伤，而他汀类药物独立于其降脂作用，通过对肾内血流动力学以及肾脏细胞因子和趋化因子表达的影响来提供肾脏保护。临床研究总体上证据不足，但最近的一项荟萃分析以及心脏保护研究的结果表明，他汀类药物可能具有肾脏保护作用。尽管如此，鉴于这些药物具有令人信服的抗动脉粥样硬化作用，包括在糖尿病患者中，它们应该广泛应用于患有肾病或有肾病风险的糖尿病患者人群。
