ABSTRACT
AIMS: To evaluate the effects of antiplatelet drugs on proteinuria, renal function, and blood pressure (BP) in patients with diabetic nephropathy (DN). MATERIALS AND METHODS: A meta-analysis of randomized controlled trials (RCTs) was performed. Relevant RCTs were identified by a systematic search of the PubMed, Cochrane Library, and Embase databases. A random-effects model was applied to pool the results. RESULTS: Antiplatelet drugs significantly reduced urinary albumin excretion (weighted mean difference (WMD) = -69.25 mg/24, p = 0.005) and the urinary albumin/creatinine ratio (standardized mean difference (SMD) = -0.33, p = 0.009). However, renal function as reflected by the estimated glomerular filtration rate (WMD = -1.15 mL/min/1.73m2, p = 0.46) and BP (systolic BP: WMD = 1.53 mmHg, p = 0.35; diastolic BP: WMD = 0.40 mmHg, p = 0.70) were not significantly affected by antiplatelet drugs within 12 months of use (p > 0.05). CONCLUSION: Antiplatelet drugs may benefit patients with DN by reducing proteinuria. The long-term effects of antiplatelet drugs on the progression of DN warrant further evaluation.â©.
Subject(s)
Diabetic Nephropathies/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Albuminuria/drug therapy , Blood Pressure/drug effects , Creatinine/urine , Diabetic Nephropathies/physiopathology , Disease Progression , Glomerular Filtration Rate/drug effects , Humans , Randomized Controlled Trials as TopicABSTRACT
There exist close relationships among oxidative stress, dyslipidaemia, inflammation, and autoimmune response in patients with systemic lupus erythematosus (SLE). Dysfunction and/or dysregulation of immunocytes is one of the major characteristics of SLE pathogenesis. Lipids play many important roles in biological processes and cellular functions. We hypothesized that oxidative stress-induced aberrant lipid metabolism and integrity presented in immunocytes is one of the early events in patients, thereby leading to enhanced production of IgG autoantibodies and cytokines. Herein, shotgun lipidomics was employed for quantitative analysis of cellular lipidomes in peripheral blood mononuclear cells (PBMC) both freshly isolated from SLE patients and cultured with treatment. The levels of IgG autoantibodies and cytokines in cell culture media and serum samples from lupus-prone mice treated with a natural, powerful antioxidant isotonix OPC-3 were measured by ELISA kits. IgG antibody deposition in glomeruli of the mice was determined by immunofluorescence analysis. Lipidomics analysis of PBMC from 33 SLE patients and 28 healthy controls revealed aberrant lipid metabolism in PBMC from the patients. The changes included significantly reduced plasmalogens, markedly increased lysophospholipids, altered phosphatidylserines, and accumulated 4-hydroxyalkenals. These alterations of lipids in SLE PBMC could be significantly corrected after cultured with the antioxidant in vitro. Parallel to the IgG antibody deposition in glomeruli, the concentrations of cytokines (i.e., IL-10, IL-6, and TNF-α) and autoantibodies (e.g., IgG antiphospholipid and anti-dsDNA antibodies) in culture medium and serum samples from the mice after treatment with the antioxidant were also significantly reduced compared with those of the SLE group. The results clearly demonstrated that correction of the aberrant lipid metabolism led to inhibition of the autoimmune reactions of PBMC after reduction of the increased oxidative stress. The current study also revealed potential drug treatment of SLE with lesser adverse effects through reducing the aberrant lipid metabolism with an effective antioxidant.