血清脂蛋白相关磷脂酶A2水平对糖尿病肾病患者尿白蛋白排泄率和血肌酐的影响

Effect of lipoprotein-associated phospholipase A2 level on urinary albumin excretion rate and serum creatinine in diabetic nephropathy patients

目的探讨血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平对糖尿病肾病(DN)患者尿白蛋白排泄率(UAER)及血肌酐(Scr)的影响。方法选择2011年1月至2014年1月在河南省人民医院就诊的2型糖尿病患者240例,根据UAER及Scr水平分为正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组和终末期肾病组,每组60例。分析各组间患者UAER、Scr水平与临床表现、生物化学检查及Lp-PLA2的关系,并分析影响UAER及Scr的独立危险因素。结果正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组及终末期肾病组组间两两比较,在Lp-PLA2、糖尿病病程、尿白蛋白-肌酐比值(ACR)方面差异均有统计学意义(P<0.05);Lp-PLA2、糖尿病病程、ACR在终末期肾病组最高,在正常白蛋白尿组最低。与正常白蛋白尿组比较,微量白蛋白尿组、大量白蛋白尿组及终末期肾病组糖化血红蛋白(Hb A1c)、三酰甘油(TG)、UAER显著升高(P<0.05)。Pearson相关分析显示,4组患者UAER与糖尿病病程、体质量指数、总胆固醇(TC)、Scr、C反应蛋白(CRP)、ACR及Lp-PLA2水平均呈正相关,与高密度脂蛋白(HDL)均呈负相关(P<0.05);Scr与年龄、糖尿病病程、TC、HDL、CRP、UAER、ACR及Lp-PLA2均呈正相关,与HDL呈负相关(P<0.05);多元线性回归分析结果显示,UAER与ACR及Lp-PLA2、糖尿病病程均呈正相关,与HDL呈负相关(P<0.05);Scr与ACR呈正相关(P<0.05);多元logistic回归分析显示,糖尿病病程、HDL、CRP、ACR和Lp-PLA2是影响UAER的独立危险因素(P<0.05),Lp-PLA2、UAER、ACR是影响Scr的独立危险因素(P<0.05)。结论 Lp-PLA2是DN蛋白尿发生及肾功能障碍的独立危险因素,可作为DN进展的指标。

Objective To investigate the effect of serum lipoprotein-associated phospholipase A2（ Lp-PLA2） level on the urinary albumin excretion rate（ UAER） and serum creatinine（ Scr） in diabetic nephropathy（ DN） patients. Methods A total of 240 patients with diabetic in Henan Provincial People＇s Hospital from January 2011 to January 2014 were selected and divided into four groups：normoalbuminuria group,microalbuminuria group,macroalbuminuria group and end-stage kidney disease group according to their levels of UAER and Scr,with 60 cases in each group. The association between UAER,Scr,and clinical situation,blood biochemical results,Lp-PLA2 were analyzed in different groups,and the independent risk factors affected UAER and Scr were analyzed. Results The difference of Lp-PLA2,the duration of diabetes and urnary albumin to creatinine ratio（ ACR） between every two groups were significant among the normoalbuminuria group,microalbuminuria group,macroalbuminuria group and end-stage kidney disease group（ P〈0. 05）;Lp-PLA2,the duration of diabetes and urnary albumin to creatinine ratio（ ACR） were the highest in end-stage kidney disease group and the lowest in normoalbuminuria group. The levels of hemoglobin A1c（ Hb A1c）,triglyceride（ TG） and UAER in microalbuminuria group,macroalbumnuria group and endstage kidney disease group were all significantly higher than those in normoalbuminuria group（ P〈0. 05）. Pearson regression analysis indicated that UAER was positive correlated with the duration of diabetes,body mass index（ BMI）,total cholesterol（TC）,Scr,c-reactive protein（CRP）,ACR and Lp-PLA2,which was negative correlation with high density lipoprotein（HDL）（P〈0. 05） in the four groups. Scr was positive correlated with the age,the duration of diabetes,TC,HDL,CRP,UAER,ACR which Lp-PLA2,and was negative correlated with HDL（ P〈0. 05）. Linear regression analysis indicated UAER was positive correlated with ACR,Lp-PLA2 and the duration of diabetes,which was negative correlated with HDL（ P〈0. 05）;Scr was positive correlated with ACR（ P〈0. 05）. Multiple logistic regression analysis found that the duration of diabetes,HDL,CRP,ACR and Lp-PLA2 were risk factors of UAER（ P〈0. 05）,and Lp-PLA2,UAER and ACR were risk factors of Scr（ P〈0. 05）. Conclusion Lp-PLA2 is an independent risk factor for albuminuria and renal function decline in DN patients,and may be used as indicators of the progress of DN.