Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.
Oxid Med Cell Longev. 2010 Sep-Oct;3(5):304-7. doi: 10.4161/oxim.3.5.13069. Epub 2010 Sep 1.
There is accumulating evidence that advanced glycation end products (AGEs) play a role in the development and progression of chronic kidney disease (CKD). We have previously found that atorvastatin treatment significantly reduces serum levels of AGEs in type 2 diabetic patients and subjects with non-alcoholic steatohepatitis in a cholesterol lowering-independent manner. In this study, we examined whether atorvastatin could reduce proteinuria partly via reduction of serum levels of AGEs in non-diabetic CKD patients. Ten non-diabetic normotensive stage I or II CKD patients with dyslipidemia were enrolled. Patients were treated with atorvastatin (10 mg/day) for 1 year. All subjects underwent determination of blood chemistries, proteinuria and serum levels of AGEs at baseline and after 1 year. Atorvastatin treatment for 1 year significantly decreased circulating levels of total cholesterol, LDL-cholesterol, triglycerides, and AGEs, while it increased HDL-cholesterol levels. Further, although atorvastatin treatment did not affect estimated glomerular filtration rate, it significantly reduced proteinuria. In univariate analyses, proteinuria levels were correlated with total cholesterol, LDL-cholesterol, triglycerides, HDL-cholesterol (inversely) and AGEs. Multiple stepwise regression analysis revealed that AGE level was a sole independent correlate of proteinuria. In this initial examination of the patients in this study, our present study suggests that atorvastatin could decrease proteinuria in non-diabetic CKD patients with dyslipidemia partly via reduction of serum levels of AGEs. Atorvastatin may have AGE-lowering effects in CKD patients as well that could contribute to renoprotective properties of this agent.
越来越多的证据表明,糖基化终产物(AGEs)在慢性肾脏病(CKD)的发生和进展中起作用。我们之前发现,阿托伐他汀治疗以胆固醇降低无关的方式显著降低 2 型糖尿病患者和非酒精性脂肪性肝炎患者的血清 AGE 水平。在这项研究中,我们研究了阿托伐他汀是否可以通过降低非糖尿病 CKD 患者的血清 AGE 水平部分减少蛋白尿。招募了 10 名患有血脂异常的非糖尿病、血压正常的 I 期或 II 期 CKD 患者。患者接受阿托伐他汀(10mg/天)治疗 1 年。所有受试者在基线和 1 年后均进行血液化学、蛋白尿和血清 AGE 水平的测定。阿托伐他汀治疗 1 年可显著降低总胆固醇、LDL-胆固醇、甘油三酯和 AGE 水平,同时增加 HDL-胆固醇水平。此外,尽管阿托伐他汀治疗不影响估计的肾小球滤过率,但它显著减少了蛋白尿。在单变量分析中,蛋白尿水平与总胆固醇、LDL-胆固醇、甘油三酯、HDL-胆固醇(呈负相关)和 AGE 相关。多元逐步回归分析显示,AGE 水平是蛋白尿的唯一独立相关因素。在对本研究患者的初步检查中,本研究表明,阿托伐他汀可通过降低血清 AGE 水平部分减少非糖尿病伴有血脂异常的 CKD 患者的蛋白尿。阿托伐他汀在 CKD 患者中可能具有降低 AGE 的作用,这可能有助于该药物的肾脏保护作用。