2型糖尿病肾病患者血清色素上皮源因子水平的变化及意义

Change and significance of serum pigment epithelium-derived factor in type 2 diabetic nephropathy

目的探讨2型糖尿病(T2DM)肾病患者血清色素上皮源因子(PEDF)水平变化及其在糖尿病肾病发生发展中的意义。方法选取49例健康对照,132例 T2DM 患者,并根据24 h 尿微量白蛋白排泄率(UAER)将患者分为正常白蛋白尿组(NA)48例、微量白蛋白尿组(MA)50例、临床蛋白尿组(PR)34例。采用酶联免疫(ELISA)法检测血清 PEDF 水平,免疫比浊法检测尿微量白蛋白,同时检测糖化血红蛋白(HbA11c)、空腹血糖(FPG)、血脂和高敏 C 反应蛋白(hs-CRP)。结果T2DM 患者血清 PEDF 水平显著高于健康对照组(2.7±1.3)mg/L,MA 组患者血清 PEDF(4.7±2.9)mg/L 显著高于 NA 组(3.7±2.2)mg/L,(P<0.01);PR 组(5.7±2.8)mg/L 显著高于 MA 组(P<0.05)。血清 PEDF 水平与 HbA1c(r=0.198,P<0.01)、FPG(r=0.231,P<0.01)、甘油三酯(TG)(r=0.302,P<0.01)、hs-CRP(r=0.214,P<0.01)和 UAER(r=0.169,P<0.05)呈显著正相关,而与高密度脂蛋白胆固醇(r=-0.237,P<0.01)呈显著负相关。多元回归分析发现 TG(β=0.314,P<0.01)、hs-CRP(β=0.260,P<0.01)、UAER(β=0.148,P<0.05)是血清 PEDF 的独立决定因子。结论 PEDF 在 T2DM 患者中显著升高,并随白蛋白尿严重程度而逐渐升高;TG、hs-CRP 和 UAER 是血清 PEDF 的独立影响因子。血清 PEDF 水平的升高可能参于了糖尿病肾病的发生和发展。

Objective To investigate the change of pigment epithelium-derived factor （PEDF） in type 2 diabetic nephropathy, and to explore the significance of PEDF in the development of diabetic nephropathy. Methods ELISA was used to detect the serum PEDF and immunoturbidimetry was used to measure the urinary albumin excretion （UAE） in 49 healthy controls and 132 type 2 diabetic patients, including 48 with normal urinary albumin excretion rate （NA group）, 50 with microalbuminuria （MA group）, and 34 with overt diabetic nephropathy （PR group）. HbA1 c, triglyceride （TG）, total cholesterol, high density lipoprotein cholesterol （ HDL-c ）, and highly sensitive C- reactive protein （hs-CRP） were simultaneously determined. Results The serum PEDF levels of the NA, MA, and PR groups were （3.7 ± 2. 2） mg/L, （4. 7±2. 9） mg/L, and（ 5.7±2. 8 ） mg/L respectively, all significantly higher than that of the control group （2.7 ± 1.3） mg/L. P 〈0.05, 0. 01, and 0.01 respectively）. The serum PEDF levels of the MA and PR groups were significantly higher than that of the NA group （both P 〈 0. 01 ）, and that of the PR group was significantly higher than that of the MA group （P 〈 0. 05 ）. Correlation analysis demonstrated that serum PEDF level was positively correlated with HbAlc （r =0. 198, P 〈0. 01 ）, FPG （r =0. 231, P 〈 0. 01 ）, TG（r = 0. 302, P 〈 0.01 ）, hs-CRP （r = 0. 214, P 〈 0. 01 ）, and urinary albumin excretion rate （UAER） （r = 0. 169, P 〈 0.05 ）, significantly, but negatively correlated with HDL-c （ r = - 0. 237, P 〈 0. 01 ）. Stepwise multiple linear regression analysis showed that TG （ β = 0. 314 ,P 〈 0. 01 ）, hs-CRP（ β = 0. 260,P 〈 0. 01 ）, and UAER （ β = 0. 148, P 〈 0. 05 ） were significant independent determinants for serum PEDF. Conclusion Serum PEDF level significantly increases in type 2 diabetic patients, and the magnitude of PEDF is related to the severity of diabetic independent determinant for serum PEDF. The increase nephropathy. TG, hs-CR and UAER are significant of PEDF may involve in the development of diabetic nephropathy.