2型糖尿病肾病患者尿白蛋白排泄率、血清脂联素与血糖水平的相互关系

Interrelationship among urinary albumin elimination rate, serum adiponectin and blood glucose level in patients with type 2 diabetic nephropathy

目的 研究2型糖尿病肾病（DN）患者尿白蛋白排泄率（UAER）、血清脂联素（ADPN）水平及血糖水平的相互关系.方法 选择89例2型糖尿病（DM）住院患者,根据尿白蛋白排泄率分为3组：单纯糖尿病组（35例）;微量白蛋自尿组（32例）;大量白蛋白尿组（22例）.30例健康体检者作为对照组.ELISA法检测血清ADPN,同时常规测定体质最指数（BMI）、腰臀比（WHR）、糖化血红蛋白（HbAlc）、血脂水平、尿白蛋白排泄率.比较各组间的差异.结果 糖尿病患者血清ADPN水平低于正常人群.大鼍白蛋白尿组的血清ADPN水平显著高于单纯糖尿病组和微量白蛋白尿组[（67.74±14.89）比（39.36±13.92）、（54.38±10.14）ng/LJ,差异有统计学意义（P＜0.05）.多元逐步回归分析显示,餐后2 h血糖（2hPG）、HbAlc、病程、UAER、高密度脂蛋白（HDL）与脂联素水平密切相关.相关分析显示,血清脂联素与HbAlc、空腹血糖（FPG）、2hPG、BMI、WHR呈负相关,r分别为-0.479、-0.436、-0.418、-0.479、-0.531,均P＜0.01;与年龄、病程、HDL、UAER呈正相关,r分别为0.255、0.405、0.501、0.843,均P＜0.01.结论 2型糖尿病患者血清脂联素水平与UAER呈正相关;与血糖水平呈负相关.血糖水平是影响血清脂联素水平的主要因素之一.严格的血糖控制有利于保持体内较高的脂联素水平.

Objective To investigate the interrelationship among urinary albumin elimination rate（UAER）,serum adiponectin（ADPN）and blood glucose level in patients with type 2 diabetic nephropathy（DN）. Methods A total of 89 type 2 diabetic patients and 30 healthy people as control were enrolled in the study.According to UAER,the diabetic patients were divided into three groups：normal group（35 cases,UAER〈30 mg/24 h）,microalbuminura group （32 cases,UAER 30-300 mg/24 h）and macroalbuminura group（22 cases,UAER〉300 mg/24 h）.Serum adiponectin was measured by ELISA.Body mass index （BMI）,waist hip radio（WHR）,fasting plasma glucose（FPG）,2-hour plasma glucose（2hPG）,glycated haemoglobin（HbAlc）,blood lipid and UAER were measured routinely.Data were compared among groups. Results Serum adiponectin level was lower in diabetic patients than that in healthy control group（P〈0.05）.Among diabetic patients.serum adiponectin of macroalbuminura group was significantly higher than that of normal and microalbuminura groups[（67.74±14.89）vs（39.36±13.92）,（54.38±10.14）ng/L,P〈0.051.Multiple regression analysis showed 2hPG,HbAlc,BMI,disease course,UAER and DBP were closely associated with the level of serum adiponectin. Correlation analysis indicated serum adiponectin was positively correlated with age （r=0.255）, disease course （r=0.405）, HDL （r=0.501）and UAER （r=0.843）; while negatively with HbAlc （r=-0.479）, FPG （r=-0.436）, 2hPG（r=-0.418）,BMI （r=-0.479） and WHR （r= -0.531）, all P〈0.01. Conclusions Serum adiponectin is positively correlated with UAER and negatively correlated with FPG. Blood glucose level is one of the main factors affecting serum adiponectin. Strict controlling of blood glucose level is beneficial to higher level of ADPN.