急性时相蛋白和IL-6及TNF-α与2型糖尿病肾病的关系

Association of acute-phase proteins,interleukin-6,tumor necrosis factor-α with diabetic nephropathy in type 2 diabetes mellitus

目的探讨2型糖尿病肾病不同阶段血清急性时相蛋白和白细胞介素6(IL-6)以及肿瘤坏死因子α(TNF-α)水平的变化及其意义。方法符合1999年WHO糖尿病诊断标准的2型糖尿病(T2DM)患者105例,按尿白蛋白排泄率(UAER)分为正常蛋白尿组(NA组)34例、微量白蛋白尿组(MA组)31例、临床蛋白尿组(CP组)30例,并以33例健康体检者作为正常对照组(NC组)。免疫散射比浊法测定血清急性时相蛋白包括C反应蛋白(CRP)、α1-酸性糖蛋白(α1-AAG)、铜蓝蛋白(CER)和触珠蛋白(THP)水平,电化学发光法测定IL-6及TNF-α水平。结果⑴T2DM患者血清急性时相蛋白和IL-6及TNF-α水平明显高于NC组(P<0.05或P<0.01)。⑵血清急性时相蛋白和IL-6及TNF-α水平随着UAER的增加而增加(P<0.05或P<0.01)。⑶MA组及CP组患者,血清急性时相蛋白与IL-6及TNF-α呈正相关(P<0.05或P<0.01)。结论T2DM肾病存在急性时相反应,炎症反应强度与肾病的严重程度有关,急性时相反应强度与IL-6及TNF-α水平相关。

Objective To study the levels of serum acute-phase proteins, interleukin-6 （IL-6） and tumor necrosis faetor-α（TNF- α） in different stages of diabetic nephropathy in type 2 diabetes mellitus （T2DM） and to explore the clinical significance. Methods One hundred and five patients with T2DM diagnosed hy WHO （1999） criteria were divided into three subgroups according to their urinary albumin excretion rate （UAER） ： 34 cases normal UAER group （ NA group）, 31 eases microalbuminuria group （ MA group） and 30 eases clinical proteinuria gruup （CA group）. Thirty-three healthy individuals were selected as controls （NC group）. The levels of acute-phase proteins including C reactive protein （CRP）, α1-aeid glyeoprotein （α1-AAG）, eeruloplasmin （CER） and haptoglobin （THP） were measured with immunoscattering assay, The levels of IL-6 and TNF-α were detected with electrochemilumineseence immunoassay. Results The levels of serum acute-phase proteins, IL-6, TNF-α were signifieantly higher in patients with T2DM than those in NC group（ all P 〈 0. 05 ）. The levels of serum acute-phase proteins, IL-6 and TNF-α gradually increased with the increment of UAER（ all P 〈 0. 05）. The levels of serum acutephase proteins were positively correlated with those of IL-6 and TNF-α in both MA group and CA group （ all P 〈 0. 05 ）. Conclusion There is an acute-phase reaction in diabetic nephropathy in patients with T2DM. The degree of aeute-phase reaction is correlated with the degree of diabetic nephropathy, and the intensity of aeute-phase reaetion is positively correlated with the levels of IL-6 and TNF-α.