不同白蛋白尿水平的2型糖尿病肾病患者血清不对称性二甲基精氨酸与血管内皮损伤的相关性研究

Correlation between asymmetric dimethylarginine and endothelial dysfunction in patients with type 2 diabetic nephropathy

目的探讨不同白蛋白尿水平的2型糖尿病肾病患者血清不对称性二甲基精氨酸（ADMA）与血管内皮损伤的相关性。方法将81例2型糖尿病肾病患者按尿白蛋白排泄率（UAER）分为微量白蛋白尿组（UAER21—199mg／24h，38例）和大量白蛋白尿组（uAER≥200mg／24h，43例），另选择20例健康体检者作为对照组，均应用彩色多普勒超声诊断仪检测右前臂桡动脉内膜．中层厚度和内皮舒张功能，并采用酶联免疫吸附法测定血清ADMA。结果三组桡动脉腔内径及内膜．中层厚度比较差异无统计学意义（P〉0．05）；微量白蛋白尿组、大量白蛋白尿组内皮依赖性舒张功能（EDD）和非内皮依赖性舒张功能（EID）均明显低于对照组[（10．45±2．58）％、（7．56±2．17）％比（15．72±3．05）％、（15．42±2．71）％、（15．37±2．92）％比（19．31±3．76）％]，大量白蛋白尿组EDD明显低于微量白蛋白尿组，差异均有统计学意义（P〈0．05）。微量白蛋白尿组、大量白蛋白尿组血清ADMA均明显高于对照组[（0．63±0．08）、（0．92±0．12）μmol／L比（0．39±0．05）μmol/L]，大量白蛋白尿组明显高于微量白蛋白尿组，差异均有统计学意义（P〈0．05）。2型糖尿病肾病患者血清ADMA与EDD呈负相关（r=-0．81，P=0．020），与C反应蛋白呈正相关（r=0．75，P=0．034）。结论2型糖尿病肾病患者血清ADMA显著升高，其升高与动脉内皮功能损伤密切相关。

Objective To investigate the correlation between asymmetric dimethylarginine （ADMA） and endothelial dysfunction in patients with type 2 diabetic nephropathy. Methods The 81 patients with type 2 diabetic nephropathy were selected. According to the urinary albumin excretion rate （UAER）, the patients were divided into micro-albuminuria group （DN 1 group, UAER 21 - 199 mg/24 h, 38 cases） and macro-albuminuria group （DN2 group,UAER〉±200 mg/24 h,43 cases）. The 20 healthy people were defined as control group. Intimal -media thickness and endothelial dysfunction of the radial artery of right forearm were detected by color Doppler ultrasound. The serum level of ADMA was determined by enzyme-linked immunosorbent assay. Results There was no significant difference in radial artery inner diameter intimal-media thickness among the 3 groups （P 〉 0.05）. The Endothelial dependent diastolic function （EDD） and endothelial independent diastolic function （EID） in DN1 group and DN2 group were significantly lower than those in control group [ （ 10.45 ± 2.58）% and （7.56 ± 2.17）% vs. （ 15.72 ± 3.05 ）%, （ 15.42 ± 2.71 ）% and （ 15.37 ± 2.92）% vs. （ 19.31 ± 3.76）%,P 〈 0.05 ], and the EDD in DN2 group was significantly lower than that in DN1 group （P〈 0.05）. The serum ADMA in DN1 group and DN2 group was significantly higher than that in control group [ （0.63 ± 0.08） and （0.92 ± 0.12） Ix mol/L vs. （0.39 ± 0.05） /±molfL,P 〈O.05],and in DN2 group it was significantly higher than that in DN1 group （P〈O.05）. In patients with type 2 diabetic nephropathy, the serum ADMA and EDD had negative correlation （r = -0.81, P = 0.020）,but the serum ADMA and C reactive protein had positive correlation （r = 0.75,P = 0.034）. Conclusions The serum level of ADMA is significantly increased in patients with type 2 diabetic nephropathy. There is a close correlation between ADMA and endothelial dysfunction of artery.