早期慢性肾脏病患者血清脂联素水平的变化

The level of serum adiponectin in patients with incipient chronic kidney disease

目的检测早期慢性肾脏病（GFR≥60ml／min）患者血清脂联素、血清白蛋白、尿蛋白排泄量、血脂、肾功能水平，探讨早期慢性肾脏病患者血清脂联素水平的变化及与各影响因素的关系。方法选择早期原发性慢性肾脏病患者42例，分为2组：肾病综合征组（19例）和非肾病综合征组（23例）。另设健康对照组（20例）。用ELISA方法检测血清脂联素，同时测定血肌酐、血清总蛋白、白蛋白、血脂和24h尿蛋白量，按公式计算体重指数（BMI），比较各组间的差别。结果患者血清脂联素水平在肾病综合征组[（21．9±11．3）mg／L]和非肾病综合征组[（11．0±7．0）mg／L]均显著升高，与对照组[（5，6±3．3）mg／L]相比，差异有统计学意义（P〈0．01），且肾病综合征组血清脂联素水平明显高于非肾病综合征组（P〈0．01）；血清脂联素与血清总蛋白（r=-n5680）、白蛋白（r=-0．6241）、BMI（r=-0．4083）呈负相关，与24h尿蛋白量呈正相关（r=0．6154）（P〈0．01）。结论在早期慢性肾脏病，尤其是大量蛋白尿患者，血清脂联素水平明显升高，并与血清白蛋白、尿蛋白量及BMI有关。血清脂联素升高的发生机制及其在慢性肾脏病中的意义尚待探讨。

Objective To examine the levels of serum adiponectin in patients with incipient chronic kidney disease （CKD, GFR ≥60ml/min,and identify the relationship between serum adiponectin and albumin （ALB）, urinary protein excretion amount, blood lipid and renal function. Methods Forty-two CKD patients and twenty normal healthy persons were involved in this study. These patients were divided into two groups ： nephrotie syndrome and non-nephrotie syndrome. The level of serum adiponeetin, serum ALB, urinary protein excretion amount, blood lipid, renal function were measured and compared. Results The level of serum adiponectin in nephritic syndrome patients [（21.9±11.3） mg/L] and non-nephrotic syndrome patients [（11.0±7.0）mg/L] was significantly higher than that in normal healthy persons[（5.6±3.3）mg/L] （P〈0.01）, and the level of serum adiponectin in nephritic syndrome patients was higher than that in non-ne-phrotie syndrome patients（ P〈0.01）. Correlative analyses revealed a negatively correlation between serum adiponeetin and serum total protein（ TP, ALB, BMI（r=-0.5680, r=-0.6241, r=-0. 4083, respectively）, and a positive correlation between serum adiponectin and urinary protein excretion amount （r=0.4083）. Stepwise regression analyses showed that serum adiponeetin was highly influenced by BMI,ALB and urinary protein excretion amount. Conclusion Serum adiponectin was markedly increased in incipient CKD, especially in patients with macroalbuminura. The effect of high level adiponectin in CKD was still not clear.