血清促红素和高迁移率蛋白B1水平与2型糖尿病患者尿蛋白的关系研究

Relationship between serum erythropoietin and HMGB1 levels and urinary protein in patients with type 2 diabetes mellitus

目的:探讨2型糖尿病患者血清促红素(EPO)和血清高迁移率蛋白B1(HMGB1)水平与尿蛋白的关系。方法:选取2型糖尿病患者80例,根据尿白蛋白/肌酐比值(UACR)分为正常蛋白尿组(UACR<30 mg/g)、微量蛋白尿组(UACR30~299 mg/g)、肾功能正常大量蛋白尿组(UACR≥300 mg/g)、肾功能不全大量蛋白尿组(UACR≥300 mg/g),每组各20例。检测所有患者血清EPO、HMGB1及相关临床生化指标水平。分析血清EPO、HMGB1之间的相关性及二者与UACR等其他临床生化指标水平的关系。结果:微量蛋白尿组、肾功能正常大量蛋白尿组和肾功能不全大量蛋白尿组糖尿病肾病(DKD)患者血清EPO浓度较正常蛋白尿组均明显降低,差异有统计学意义(P<0.05),且EPO浓度随着UACR增加而降低。EPO与尿素氮、血肌酐呈明显负相关,与肾小球滤过率(eGFR)呈正相关。肾功能正常大量蛋白尿组和肾功能不全大量蛋白尿组患者血清HMGB1浓度较正常蛋白尿组均显著增高,差异有统计学意义(P<0.01);HMGB1与BUN、Cr和UACR呈正相关,与eGFR呈负相关。EPO和HMGB1两者间呈负相关。结论:2型DKD患者血清EPO浓度降低、HMGB1水平升高,且与肾脏损害严重程度相关,血清EPO和HMGB1水平可为DKD的临床预测或治疗提供新思路。

Objective:To investigate the relationship between serum erythropoietin(EPO),high mobility protein B1(HMGB1)and urinary protein in patients with type 2 diabetes mellitus.Methods:80 patients with type 2 diabetes were selected,according to the ratio of urinary albumin to creatinine(UACR),they were divided into groupⅠ(UACR<30 mg/g),groupⅡ(UACR=30~299 mg/g),groupⅢ(UACR≥300 mg/g,normal serum creatinine)and groupⅣ(UACR≥300 mg/g,serum creatinine increased),with 20 cases in each group.The levels of serum EPO,HMGB1 and related clinical biochemical indexes were detected.We used correlation analysis to analyze the correlation between serum EPO and HMGB1,and their relationship with UACR and other clinical biochemical indexes.Results:Compared with the normal urine protein group,the serum EPO concentration in the three groups of diabetic nephropathy patients was significantly lower,the difference was statistically significant(P<0.05),the concentration of EPO decreased with the increase of UACR.EPO was negatively correlated with urea nitrogen and serum creatinine,and positively correlated with estimated glomerular filtration rate(EGFR).Compared with normal urine protein group,the serum HMGB1 concentration in patients with massive proteinuria and renal insufficiency was significantly increased,the difference was statistically significant(P<0.05).HMGB1 was positively correlated with BUN,Cr and UACR,and negatively correlated with eGFR.There was a negative correlation between EPO and HMGB1.Conclusion:In patients with type 2 diabetic nephropathy,the serum EPO concentration decreased and the HMGB1 level increased,and it is related to the severity of renal damage,serum EPO and HMGB1 levels can provide new ideas for clinical prediction or treatment of diabetic nephropathy.