2型糖尿病肾病患者血清脂联素、血管内皮生长因子水平与氧化应激的相关性

Association of Serum Adiponection and Vascular Endothelial Growth Factors with Oxidative Stress in Type 2 Diabetic Nephropathy

目的:探讨2型糖尿病肾病(DN)不同阶段血清脂联素(APN)、血管内皮生长因子(VEGF)变化及其与氧化应激的关系。方法:将符合1999年WHO诊断标准的2型糖尿病患者根据24h尿蛋白排泄率分为3组,即正常白蛋白尿组(SDM)、微量白蛋白尿组(NA)、大量蛋白尿组(MA)。另设正常对照组(NC)。采用双抗夹心ELISA法检测DN患者血清APN、VEGF水平,采用比色法测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)含量。结果:①DN患者血清APN水平低于正常对照组;DN患者各组间比较,大量蛋白尿组的血清APN水平最低,差异有统计学意义(P<0.05);血清VEGF水平在NA、MA组明显高于SDM组和NC组,差异有统计学意义(P<0.05)。②与NC组比较,SOD活性及GSH-Px水平在糖尿病各组明显下降(P<0.01),MDA水平在NA组、MA组明显升高(P<0.01)。③糖尿病患者血清APN与UAER、MDA、VEGF浓度呈负相关(P<0.05),与SOD、GSH-Px呈显著正相关(P<0.01);血清VEGF浓度与病程、HbA1c、UAER、MDA的升高呈正相关(P<0.05),与SOD、GSH-Px呈显著负相关(P<0.01)。结论:DN患者血清APN、VEGF水平与氧化应激密切相关,低APN血症是2型糖尿病及DN发生的危险因素,VEGF升高可能是DN的危险因素。

Objective： To investigate the association of serum adiponection（APN） and vascular endothelial growth factors（VEGF） with oxidative stress in different stages of diabetic nephropathy.Methods： Twenty-five healthy subjects（NC） and 105 patients with type 2 diabetes mellitus,which were sub-divided into three groups according to their uriary albumin excretion rate（UAER） as： normal UAER group（SDM group,n=35）,microalbuminuria group（NA group,n=35）,and clinical proteinuria group（MA group,n=35）.Serum APN and VEGF were measured by ELISA,and superoxide dismutase（SOD）,serum malondialdehyde（MDA） and glutathione peroxidase（GSH-Px） were determined by chemical chromatometry.Results： ①The level of serum APN was lower in diabetic nephropathy patients than in NC group（P0.05）.Among diabetic patients,the serum APN in MA group was significantly lower than that in SDM and NA groups（P0.05）;the serum VEGF in NA and MA groups were significantly higher than that in NC and SDM groups（P0.05）.②As compare with that respectively in NC group,the activity of SOD and serum GSH-Px level in the three diabetic groups were significantly lower（P0.01）.Serum MDA level was increased significantly in NA and MA groups（P0.01）.③For the patients,serum APN was negatively correlated with UAER,MDA,and VEGF（P0.05）,and positively correlated with SOD and GSH-Px（P0.01）.Serum VEGF was positively correlated with duration of disease,HbA1c,UAER,and MDA（P0.05）,and negatively correlated with SOD and GSH-Px（P0.01）.Conclusion： In patients with diabetic nephropathy,serum APN and VEGF were correlated with SOD and other oxidative stress indices.Lower serum APN was a risk factor to diabetes and diabetic nephropathy,while elevated VEGF may be a risk factor of the onset of diabetic nephropathy.