Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Endocr J. 2011;58(8):663-74. doi: 10.1507/endocrj.k11e-080. Epub 2011 Jun 14.
We aimed to assess the effects of rosuvastatin treatment on lipid levels, albuminuria, and kidney function in patients with chronic kidney disease (CKD). We conducted a prospective, open-label, study of 91 patients with CKD, low-density lipoprotein cholesterol (LDL-C) levels > 120 mg/dL, and well-controlled blood pressure who were undergoing treatment with renin-angiotensin system inhibitors. Subjects were treated with 2.5 mg/day rosuvastatin, which was increased to 10 mg/day for the 24-week study period. Rosuvastatin effectively reduced total cholesterol, LDL-C, triglycerides, non-high density lipoprotein cholesterol (non-HDL-C) levels, and the LDL-C/HDL-C ratio. Although there was no significant change in the estimated glomerular filtration rate (eGFR), serum cystatin C levels and urinary albumin/creatinine ratio were significantly decreased. Subjects were divided into 2 groups: with and without diabetes mellitus (DM). Percent changes of HDL-C, C-reactive protein (CRP), and malondialdehyde-modified (MDA)-LDL were significantly higher in the DM group than in the non-DM group. Furthermore, when the subjects were divided into 2 groups based on eGFR levels (60 mL/min/1.73 m(2) or more, normal-GFR group; less than 60 mL/min/1.73 m(2), decreased-GFR group), the percent reduction of non-HDL-C, CRP, MDA-LDL levels, and albuminuria of DM subjects in the decreased-GFR group were significantly higher than those in the non-DM subjects. Multivariate analysis identified a change in cystatin C to be associated with decreased albuminuria during rosuvastatin treatment. Rosuvastatin administration reduced albuminuria, serum cystatin C levels, and inflammation, and improved lipid profiles, regardless of the presence or absence of DM, and the degree of the eGFR.
我们旨在评估瑞舒伐他汀治疗对慢性肾脏病（CKD）患者的血脂水平、蛋白尿和肾功能的影响。我们进行了一项前瞻性、开放标签的研究，纳入了 91 例患有 CKD、低密度脂蛋白胆固醇（LDL-C）水平＞120mg/dL 且血压控制良好的患者，这些患者正在接受肾素-血管紧张素系统抑制剂治疗。患者接受 2.5mg/天的瑞舒伐他汀治疗，在 24 周的研究期间增加至 10mg/天。瑞舒伐他汀有效地降低了总胆固醇、LDL-C、甘油三酯、非高密度脂蛋白胆固醇（non-HDL-C）水平和 LDL-C/HDL-C 比值。尽管估计肾小球滤过率（eGFR）没有显著变化，但血清胱抑素 C 水平和尿白蛋白/肌酐比值显著降低。患者被分为 2 组：有糖尿病（DM）和无糖尿病（非-DM）。DM 组的 HDL-C、C 反应蛋白（CRP）和丙二醛修饰（MDA）-LDL 的百分比变化明显高于非-DM 组。此外，当根据 eGFR 水平（60mL/min/1.73m²或更高，正常 GFR 组；低于 60mL/min/1.73m²，降低 GFR 组）将患者分为 2 组时，降低 GFR 组中 DM 患者的非-HDL-C、CRP、MDA-LDL 水平和蛋白尿的降低百分比明显高于非-DM 患者。多变量分析发现，胱抑素 C 的变化与瑞舒伐他汀治疗期间的蛋白尿减少有关。瑞舒伐他汀治疗可降低蛋白尿、血清胱抑素 C 水平和炎症，并改善血脂谱，无论是否存在 DM 以及 eGFR 的程度如何。
