2型糖尿病患者血清脂蛋白(a)水平变化对肾功能的影响

Observation of relationship between different level of serum lipoprotein(a) and renal function in Type II diabetics

目的:探讨2型糖尿病血清脂蛋白(a)水平变化对肾功能的影响以及降低脂蛋白(a)水平在防治早期糖尿病肾病(DN)进展中的意义。方法:(1)根据尿白蛋白排泄率(UAER)测定结果将132例糖尿病患者分为单纯DM组(56例)和早期DN组76例,比较上述两组和正常对照组(56例)的脂蛋白(a)水平;(2)将76例早期DN患者随机分为两组,对照组(30例)予常规治疗,治疗组(46例)在常规治疗基础上每晚服用阿托伐他汀20mg。分别于治疗前和治疗后6周末检测脂蛋白(a)、FBG、UAER和血肌酐,分析脂蛋白(a)水平变化与早期DN进展之间的关系。结果:(1)单纯DM组脂蛋白(a)水平与正常对照组比较无显著性差异(P>0.05),早期DN组血清脂蛋白(a)水平明显高于正常对照组和单纯DM组(P<0.01),脂蛋白(a)水平与UAER呈直线正相关(P<0.01)。(2)治疗组血清脂蛋白(a)水平显著降低(P<0.01),且随着脂蛋白(a)水平的下降,UAER和血肌酐亦同步下降。结论:血清脂蛋白(a)水平升高与DN进展有关,降低血清脂蛋白(a)水平能有效减少早期DN患者的尿蛋白排泄,延缓肾功能减退。

Objective： To investigate the effect on renal function of different levels of lipoprotein（a）, and the relationship between lipoprotein（a） levels and progression of early diabetic nephropathy（EDN ） and the significance of lowering of serum Lp（a） in preventing progression of EDN in type 2 diabetics. Methods： Serum Lp （a） concentration was measured and compared between non--diabetic controls and type 2 diabetes mellitus patients including 56 patients without DN [urinary albumin excretion rate （UAER）〈30 mg/24h, group DM] and 76 with microalbuminuria（UAER 30-300 mg/ 24h,group EDN）. Seventy-six patients with EDN were randomly divided into control group （n=30） and treatment group （n=46） which was treated with 20 microgram of oral atorvastatin every night in addition to routine therapy. All patients were followed up for 6 weeks. Lp （a）, FBG, UARE and Scr in both groups were compared 6 weeks before and after the treatment. Results： Lp（a） levds were similar between DM group and non-diabetic contruls（P〉0.05 ）. But in the group of EDN, Lp（a） was significantly higher than those of the former two groups（P〈0.01 ）. There was a positive correlation between Lp（a） concentration and UAER（r=0.7466,P〈0.01 ）. Lp（a） significantly decreased in the treatment group（P〈0.01 ）,accompanied by decrease in UAER and Set. Conclusion： Increased serum Lp（a） may be associated with the progression of EDN. Lowering serum Lp（a） can ameliorate microalbuminuria and postpone the occurrence of renal function failure in patients with type 2 diabets.