부산대학교 도서관

Background Inflammation may contribute to the high cardiovascular risk in diabetes mellitus ( DM) and chronic kidney disease ( CKD). Monocyte chemoattractant protein-1 ( MCP-1) facilitates the recruitment of monocytes into atherosclerotic lesions and is involved in diabetic nephropathy. Interferon gamma ( IFNγ) is important in atherosclerosis and increases the synthesis of chemokines including MCP-1. Lipid-lowering treatment ( LLT) with statins may have anti-inflammatory effects, and ezetimibe cotreatment provides additional cholesterol lowering. Methods After a placebo run-in period, the effects of simvastatin alone (S) or simvastatin + ezetimibe (S+E) were compared in a randomized, double-blind, cross-over study on inflammatory parameters. Eighteen DM patients with estimated glomerular filtration rate ( eGFR) 15-59 mL/min × 1·73 m2 (CKD stages 3-4) (DM-CKD) and 21 DM patients with eGFR > 75 mL/min (DM only) were included. Results At baseline, monocyte chemoattractant protein 1 (MCP-1) ( P = 0·03), IFNγ ( P = 0·02), tumour necrosis factor-α (TNFα) ( P < 0·01) and soluble vascular adhesion molecule ( sVCAM) ( P = 0·001) levels were elevated in DM-CKD compared with DM-only patients. LLT with S and S+E reduced MCP-1 levels ( P < 0·01 by anova) and IFNγ levels ( P < 0·01) in DM-CKD patients but not in DM-only patients. Reductions were most pronounced with the combination treatment. Conclusions DM patients with CKD stages 3-4 had increased inflammatory activity compared with DM patients with normal GFR. Lipid-lowering treatment decreased the levels of MCP-1 and IFNγ in DM patients with concomitant CKD, which may be beneficial with regard to the progression of both atherosclerosis and diabetic nephropathy. [ABSTRACT FROM AUTHOR]