糖尿病肾病尿CD62P的表达与内皮素-1的变化

Change of urinary platelet CD62P and ET-1 in diabetic nephropathy

目的:观察不同程度蛋白尿的糖尿病肾病(diabetic nephropathy,DN)患者尿CD62P表达和内皮素-1(Endothelin,ET-1)的变化,研究肾脏局部血小板活化及内皮细胞损伤在DN发生和发展中的作用。方法:随机选取90例2型DN患者为实验组,根据尿白蛋白排泄率(urinary albumin excretion rate,UAER)分为正常蛋白尿组、微量蛋白尿组、大量蛋白尿组;另选择20例未合并DN的糖尿病患者作为DM组,20例健康人作为健康对照组,检测并比较各组血及尿中CD62P阳性表达及尿ET-1水平。结果:(1)血CD62P阳性表达率:DN组高于健康对照组、DM组,DM组高于健康对照组(P<0.05);DM组与正常蛋白尿组间无明显差异(P>0.05);正常蛋白尿组、微量蛋白尿组、大量蛋白尿组比较差异有统计学意义(P<0.05)。(2)尿CD62P阳性表达率:DN组高于健康对照组、DM组(P<0.05),健康对照组与DM组无明显差异(P>0.05);DM组与正常蛋白尿组间差异显著(P<0.05)。DN患者尿ET-1水平高于健康对照组;正常蛋白尿组、微白蛋白尿组、大量蛋白尿组尿CD62P阳性表达率及尿ET-1比较差异均有统计学意义(P<0.05)。(3)尿CD62P阳性表达率与尿ET-1水平、尿白蛋白排泄率(UAER)及血CD62P阳性细胞率呈明显正相关;尿ET-1与UAER呈明显正相关。结论:(1)肾脏局部的血小板活化及内皮细胞损伤参与了DN的发生和发展;(2)尿CD62P阳性表达率及尿ET-1水平可能较UAER更早提示DN的发生,尿CD62P阳性表达及尿ET-1水平升高可能成为DN的早期预测指标。

Objective： To study change of urinary platelet CD62P and changes of endothelin in dia- betic nephropathy （DN） patients. Methods： A total of 90 patients of type 2 DN were selected, and ran- domly for the test divided into normal albuminuria group, microalbuminuria group, and macroalbuminu-rine group, according to urinary albumin excretion rate. Another 20 healthy subjects were selected as nor- mal control group, 20 diabetic without albuminuria were selected as DM group. Blood and urinay plateletCD62P expression, urinary endothelin were detected. Results： Plasma platelet CD62P positive expression rate was as follows： DN group 〉 DM group 〉 health group（P〈0.05）. There was no significant differ-ence between DM group and normal albuminuria group（P〉0.05）, while the difference among normal al- buminuria group,microalbuminuria group, and macroalbuminurine group was significant （P〈0.05）. Uri-naray platelet CD62P positive expression in DN group was significantly higher than that of healthy popula- tion and DM group; There was no significant difference between DM group and healthy group（P〉0.05）.There was significant difference between DM group and normal albuminuria group（P〈0.05）. ET-1 level of DN group was higher than heathy control group. The differences in CD62P positive rate and ET-1 levelamong normal albuminuria group, microalbuminuria group, and macroalbuminurine group were significant （P〈0.05）. Urinary platelet CD62P positive rate was significantly positively correlated with urinary ET-1levels, urinary albumin excretion rate and plasma CD62P positive rate; the level of urinary ET-1 and urina- ry albumin excretion rate was significantly correlated. Conclusions. In kidney localized platelet activationand endothelial cell damage are involved in the occurrence and development of DN. Compared with urinary albumin excretion rate, urinary platelet CD62P expression rate may be earlier in promoting the occurrenceof diabetic nephropathy.