2型糖尿病肾病患者血清脂联素水平的变化

Significance of serum adiponectin in type 2 diabetic patients with nephropathy

目的:观察2型糖尿病肾病(DN)患者血清脂联素(adiponectin,ADPN)水平变化及其临床意义。方法:正常对照组(NC)10例;2型糖尿病患者53例,根据尿白蛋白排泄率(UAER)及血清肌酐(SCr)水平分成糖尿病组(DM,UAER<30mg/g,SCr<132.6μmol/L)、糖尿病肾病组(DN1,≥30mg/g,SCr<132.6μmol/L)和晚期糖尿病肾病组(DN2,UAER≥300mg/g,SCr>132.6μmol/L);应用酶联免疫吸附法(ELISA)测定各组血清中的ADPN、可溶性血管细胞粘附分子1(sVCAM-1)水平。结果:DN2组的血清ADPN水平高于NC组、DM组和DN1组(P<0.05);DN1组的ADPN高于NC组和DM组,但无统计学差异;DM组的ADPN水平低于NC组,但无统计学差异。sVCAM-1在NC组、DM组、DN1组和DN2组依次逐渐增高。相关分析显示ADPN与尿酸(UA)、SCr、肾小球滤过率(eGFR)呈显著相关关系(P<0.05),多元逐步回归分析显示SCr是ADPN的独立相关因素(决定系数为r2=0.265,β=3.130,P<0.01)。无论在研究对象总体还是糖尿病患者中,ADPN与sVCAM-1均呈正相关性(相关系数分别为0.331,P<0.01;0.316,P<0.05)结论:2型糖尿病肾病患者血清ADPN水平升高可能与肾功能减退有关,血清ADPN升高可能参与了糖尿病肾病患者的内皮功能损害机制。

Objective：To measure the serum level of adiponectin （ADPN） and soluble vascular cell adhesion molecule （sVCAM-1） , an endothelial cell injury marker, and to evaluate the relationship of ADPN and sVCAM-1 in type 2 diabetic patients with nephropathy. Methodology：A total of fifty-three type 2 diabetic patients with nrphropathy and 10 control （NC） subjects were enrolled in this study. They were matched for body mass index （BMI） , age and sex. According to the progression of nephropatby, these patients were divided into three groups ： DM （ mieroalbuminuria 〈 30 mg/d, serum creatinine 〈 147.6 μmol/L） ; DN1 （ albuminuria 〉 30 mg/d, serum creatinine 〈 147. 6 μ mol/L） ; DN2 （ macroalbuminuria, albuminuria 〉 300 mg/d , serum ereatinine 〉 147.6 μmol/L）. The renal function was estimated with the MDRD formula. The levels of serum ADPN and sVCAM-1 were measured by enzyme-linked immunosorbent assay （ ELISA ）. Results： The levels of serum ADPN were relatively lower in group DM than that in group NC, and significantly higher in the advanced stages of diabetic nephropathy [ NC （6. 58 ± 3.10） mg/L, DM （4. 97 ± 2. 89） mg/L, DN1 （10. 0 ±9. 0） mg/L, DN2 （15.82±6. 53） mg/L, P 〈 0.01 ]. The levels of serum sVCAM-1 were steadily increased with the progression of DN, and that in the group DN2 was significantly increased compared with that in the group NC （ P 〈 0. 05 ）. Serum ADPN positively correlated with serum creatinine （ r = 0. 296, P 〈 0. 05 ）, uric acid （ r = 0. 313, P 〈 0. 05 ） and negatively correlated with eGFR （ r = - 0. 320, P 〈 0. 05 ）. In stepwise multiple regression analysis adjusted for established risk factors, serum creatinine was selected to be an independent determinants of serum ADPN levels （ β = 3. 130, P 〈 0. 01 ）. Interestingly, there was a positive association between serum ADPN and sVCAM-1 level in all tested samples （r = 0. 331, P 〈 0. 01 ） and in diabetic patients （r = 0. 316, P 〈 0.05 ）. Conclusion：The high level of serum ADPN in DN may be associated with renal insufficiency, which might be involved in the endothelial dysfunction.