Department of Pediatrics, Faculty of medicine, Ain shams University, Cairo, Egypt.
Department of Clinical Pathology, Faculty of medicine, Ain shams University, Cairo, Egypt.
Pediatr Diabetes. 2018 May;19(3):470-477. doi: 10.1111/pedi.12564. Epub 2017 Jul 26.
Oxidative stress is a significant contributor to the pathogenesis of diabetic nephropathy. Carnosine is a natural radical oxygen species scavenger. We investigated the effect of carnosine as an adjuvant therapy on urinary albumin excretion (UAE), the tubular damage marker alpha 1-microglobulin (A1M), and oxidative stress in pediatric patients with type 1 diabetes and nephropathy.
This randomized placebo-controlled trial included 90 patients with diabetic nephropathy, despite oral angiotensin-converting enzyme inhibitors (ACE-Is), who were randomly assigned to receive either 12 weeks of carnosine 1 g/day (n = 45), or matching placebo (n = 45). Both groups were followed-up with assessment of hemoglobin A1c (HbA1c), UAE, A1M, total antioxidant capacity (TAC) and malondialdhyde (MDA).
Baseline clinical and laboratory parameters were consistent between carnosine and placebo groups (P > .05). After 12 weeks, carnosine treatment resulted in significant decrease of HbA1c (8.2 ± 2.1% vs 7.4 ± 1.3%), UAE (91.7 vs 38.5 mg/g creatinine), A1M (16.5 ± 6.8 mg/L vs 9.3 ± 6.6 mg/L), MDA levels (25.5 ± 8.1 vs 18.2 ± 7.7 nmol/mL) while TAC levels were increased compared with baseline levels (P < .001) and compared with placebo (P < .001). No adverse reactions due to carnosine supplementation were reported. Baseline TAC was inversely correlated to HbA1c (r = -0.58, P = .04) and A1M (r = -0.682, P = .015) among carnosine group.
Oral supplementation with L-Carnosine for 12 weeks resulted in a significant improvement of oxidative stress, glycemic control and renal function. Thus, carnosine could be a safe and effective strategy for treatment of pediatric patients with diabetic nephropathy.
氧化应激是糖尿病肾病发病机制的重要因素。肌肽是一种天然的活性氧自由基清除剂。我们研究了肌肽作为辅助治疗对患有 1 型糖尿病肾病的儿科患者尿白蛋白排泄（UAE）、肾小管损伤标志物α1-微球蛋白（A1M）和氧化应激的影响。
本随机安慰剂对照试验纳入了 90 名接受口服血管紧张素转换酶抑制剂（ACE-Is）治疗但仍患有糖尿病肾病的患者，他们被随机分配接受 12 周的肌肽 1g/天（n=45）或匹配的安慰剂（n=45）治疗。两组均进行血红蛋白 A1c（HbA1c）、UAE、A1M、总抗氧化能力（TAC）和丙二醛（MDA）评估。
肌肽组和安慰剂组的基线临床和实验室参数一致（P>.05）。12 周后，肌肽治疗可显著降低 HbA1c（8.2±2.1% vs 7.4±1.3%）、UAE（91.7 vs 38.5mg/g 肌酐）、A1M（16.5±6.8mg/L vs 9.3±6.6mg/L）、MDA 水平（25.5±8.1 vs 18.2±7.7nmol/mL），同时 TAC 水平较基线升高（均 P<.001），且与安慰剂组相比也升高（均 P<.001）。未报告因肌肽补充而出现不良反应。肌肽组中，基线 TAC 与 HbA1c（r=-0.58，P=.04）和 A1M（r=-0.682，P=.015）呈负相关。
口服肌肽补充 12 周可显著改善氧化应激、血糖控制和肾功能。因此，肌肽可能是治疗儿童糖尿病肾病的一种安全有效的策略。
