血清C反应蛋白、白介素6和肿瘤坏死因子α与2型糖尿病肾病的关系

Relationship between serum C-reactive protein,interleukin-6, tumor necrosis factor-α and diabetic nephropathy

目的 研究血清炎症因子- C反应蛋白(CRP)、肿瘤坏死因子(TNF)- α、白介素- 6 (IL- 6)、白细胞计数(WBC)在2型糖尿病肾病中的变化。方法 2 型糖尿病100 例,其中糖尿病肾病60 例,分为早期肾病(DN1)组33例,临床肾病(DN2)组27例,2型糖尿病无白蛋白尿组(DM)40 例,健康对照组30 例;分别测定血清超敏CRP、IL- 6、TNF- α、WBC。结果 DM组血清CRP(5.80±3.20) mg/L、IL 6(10.0±4.5) ng/L、TNF- α(16.2±8.5) ng/L较正常对照组升高[分别为(2.90±1.80) mg/L、(7.3±2.0) ng/L、(13.0±4.1) ng/L(P<0.05)];DN1、DN2 两组的血清CRP、IL 6、TNF- α及WBC均较DM组、正常对照组升高(P<0.05或P<0.01);DN2 组(12.50±8.60) mg/L又较DN1组(7.20±5.00) mg/L, CRP 升高(P < 0.05)。相关分析发现,血清CRP 与TC 呈正相关( r = 0.510, P <0.01);血清IL 6与总胆固醇( r=0.271,P<0.01)及糖化血红蛋白( r=0.351,P<0.01)呈正相关。血清TNF -α、WBC计数与体质量指数( r=0.236,P<0.01;r=0.254,P<0.01) 呈正相关。结论 糖尿病肾病患者血清炎症因子水平升高,与尿蛋白排泄率呈正相关。血清超敏CRP、IL 6、TNF- α、WBC的测定可作为判断2 型糖尿病肾损害程度及预后的指标。

Objective To study the changes of C-reactive protein,interleukin-6(IL-6),tumor necrosis factor-α(IFN-α),white blood cells(WBC) in type 2 diabetic nephropathy.Methods One hundred patients with type 2 diabetes (1999 WHO diagnostic standards) were selected for this study.The patients were divided into three groups according to urinary albumin excretion rate(UAER): 40 patients with normal UAER were DM group,33 patients with microalbuminuria were DN1 group and 27 patients with clinical protein uria were DN2 group.Thirty healthy subjects were used as control group.The serum levels of C-reactive protein (CRP),IL-6,TNF-α were measured with chemiluminescent immunoassay.Results The serum levels of CRP ( 5.80± 3.20) mg/L,IL-6 ( 10.0± 4.5) ng/L,TNF-α( 16.2± 8.5) ng/L in DM were significantly higher than those of control group ( 2.90± 1.80) mg/L,( 7.3± 2.0) ng/L,( 13.0± 4.1) ng/L,respectively(P< 0.05).In DN1 and DN2 group,the serum levels of CRP,IL-6,TNF-α and WBC were significantly different in comparison with those of control group (P< 0.05 or P< 0.01) and DM group (P< 0.05).The serum level of CRP in DN2 ( 12.50± 8.60) mg/L was higher than that of DN1 ( 7.20± 5.20) mg/L(P< 0.05).Significantly correlations were found among serum CRP and IL-6 with Tc(r= 0.510,P< 0.01;r= 0.271,P< 0.01),serum TNF-α and WBC with BMI (r= 0.236,P< 0.01;r= 0.254,P< 0.01),serum IL-6 with HbA 1c(r= 0.351,P< 0.01).Conclusion The serum levels of inflammatory factors increased with urinary albumin in type 2 diabetic patients.Serum levels of CRP,IL-6,TNF-α and WBC in type 2 diabetic patients may be reliable clinical markers for assessing the severity and prognosis of diabetic nephropathy.