TNF-α与糖尿病肾病关系的研究

STUDY OF THE RELATIONSHIP BETWEEN SERUM TUMOR NECROSIS FACTOR ALPHA AND DIABETIC NEPHROPATHY

目的:通过测定正常人、2型糖尿病及糖尿病肾病病人血清TNF-α的水平,探讨TNF-α与2型糖尿病和糖尿病肾病的关系,及其在糖尿病肾病发生、发展中的作用。方法:入选研究对象54例,分为3组:1.正常对照组,13例。2.单纯糖尿病组(即2型糖尿病未合并肾病组)21例。3.糖尿病肾病组,20例。各组间年龄性别无显著差异。所有入选病例均测定体重指数(BMI)、空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血浆胰岛素(FINS)、尿清蛋白排泄率(UAER)及肿瘤坏死因子-α(TNF-α)。TNF-α测定使用酶联免疫吸附法(ELISA),并将TNF-α与其他指标在三组之间进行比较。结果:(1)血清TNF-α在单纯糖尿病组及糖尿病肾病组均显著高于正常对照组(P<0.05或P<0.01),且糖尿病肾病组显著高于单纯糖尿病组(P<0.01)。(2)单纯糖尿病组与糖尿病肾病组病程的比较无显著差异(t=-2.984,P=0.005)。(3)单因素相关分析显示:血清TNF-α与BMI(r=0.321,P=0.018)、GHbA1C(r=0.312,P=0.022)、FPG(r=0.369,P=0.006)及UAER(r=0.420,P=0.002)呈正相关,而与年龄、病程、血脂、FINS无明显相关(P>0.05)。结论:1.TNF-α可能与2型糖尿病及糖尿病肾病相关,且可能是2型糖尿病及糖尿病肾病发生发展的危险因素之一。2.血清TNF-α的检测可作为判断糖尿病肾病损害程度及预后的指标。

Objective： Through determining the level of serum tumor necrosis factor alpha （ TNF - α） in normal people and type 2 diabetes with/without diabetic nephropathy（DN） ,to probe into the relationship between TNF - α and type 2 diabetes with or without DN, and to explore the role of TNF - α in the initiation and progression of them. Methods ：54 subjects in our hospital were selected and divided them into 3 groups： 1. Normal control group （n = 13 ）. 2. Simple diabetes mellitus group （n = 21 ）, namely T2DM patients without diabetic nephropathy. 3. Diabetic nephropathy group（ n = 20）. There were no significant differences in age and sex between groups. All the subjects were measured BMI, FPG, GHbA1 C, HDL - C, LDL - C, TC, TG, FINS, UAER and TNF - α. The level of serum TNF - α were detected with the enzyme -linked immunosorbent assay（ ELISA）, and compared these indexes between groups. Results： （ 1 ） The levels of serum TNF - α in diabetic patients with or without DN were significantly elevated as compared with the normal control group（P 〈0.05 or P 〈0. 01 ） ,and TNF - α in diabetic nephropathy group was significantly higher than the simple diabetes mellitus group （P 〈 0. 01 ）. （2）There were no significant differences in course between simple diabetes mellitus group and DN group （ t = - 2. 984, P = 0. 005 ）. （ 3 ） Single factor correlation analysis showed ： serum TNF - α was positively correlated with BMI （ r = 0. 321, P = 0. 018 ）, FPG （ r = 0. 369, P = 0. 006 ）, GHbA1 C （ r = 0. 312, P = 0. 022 ） and UAER （ r = 0. 420, P = 0. 002 ）, in addition, it had no correlation with age, course,blood fat and FINS（P 〉0. 05）. Conclusion： （ 1 ）There may be relations between TNF - α and the initiation and progression of type 2 diabetes and diabetic nephropathy, in addition, TNF - α may be one of the risk factors of type 2 diabetes and diabetic nephropathy. （2） Detecting the level of serum TNF - α may be a clinical marker for assessing the severity and prognosis of DN.