2型糖尿病肾病患者血清及尿液PEDF水平及意义

Significance of serum and urine pigment epithelium-dirived factor in type 2 diabetic nephropathy

目的:本研究通过观察色素上皮衍生因子(pigment epithelium derived factor,PEDF)在2型糖尿病肾病不同时期患者血清及尿液中的表达水平,探讨PEDF与糖尿病肾病(diabetic nephropathy,DN)病情进展的关联,进一步研究血清及尿液PEDF检测的临床意义。方法:选择研究对象共120例,分为健康对照组(n=30)、单纯糖尿病组(2型糖尿病、非糖尿病肾病组n=30),糖尿病肾病Ⅲ期(微量蛋白尿组、n=30)、Ⅳ期患者(临床蛋白尿组、n=30),采用酶联免疫(enzyme-linked immuno sorbent assay,ELISA)法检测空腹血清PEDF,尿液PEDF水平,静脉空腹血糖(fasting plasma glucose,FPG)、三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白-胆固醇(low density lipoprotein,LDL-C)、糖化血红蛋白(glycosylated hemoglobin,Hb A1c)、血肌酐(serum creatinine,s Cr)、尿素氮(blood urea nitrogen,BUN)、24小时尿白蛋白(24 h-urinary albumin excretion,24h UAlb),计算尿白蛋白排泄率(urinary albumin excretion ratio,UAER)。结果:健康对照组、单纯糖尿病组、微量蛋白尿组、临床蛋白尿组患者血清中PEDF水平逐渐增高(5.51±0.44、6.27±0.52、8.85±0.68、12.44±0.87μg/m L),各组间有显著性差异(F=13.07,P<0.05)。各组尿液PEDF水平逐渐增高(4.98±0.21、5.20±0.18、6.29±0.46、8.63±0.85μg/m L),各组间差异有统计学意义(F=20.52,P<0.01)。尿白蛋白排泄率与血清PEDF含量成正相关(r=0.880,P<0.01);与尿液PEDF含量成正相关(r=0.809,P<0.01)。结论:本研究观察到不同时期糖尿病肾病患者血清及尿液PEDF水平随着病情进展逐渐升高,提示PEDF在DN的发生发展中可能起着重要作用,联合检测血清PEDF和尿液PEDF水平对糖尿病肾病早期诊断可能有重要意义。

Objective： To investigate the change of serum and urine pigment epithelium derived factor （PEDF） in type 2 diabetic nephropathy （DN）, and to explore the significance of PEDF in the development of diabetic nephropathy.Investigate whether PEDF could be an early diagnosis marker in DN. Methods： ELISA was used to detect the serum and urine PEDF in 30 healthy controls （NC group） and 90 type 2 diabetic patients, including 30 with normal albumin excretion rate （DM group）, 30 with microalbumin （DN III group）, and 30 with overt diabetic nephropathy （DN IV group）, fasting plasma glucose （FPG）. Glycosylated hemoglobin （HbAlc）, triglyceride （TG）, total cholesterol （TC）, low density liloprotein cholesterol （LDL-C）, serum creatine （sCr）, blood urea nitrogen （BUN）, 24h-urinary albumin excretion （24hUAlb）, were simultaneously determined. Results： The serum PEDF levels ofNC, DM, DN IU, DNIVgroups were （5.51±0.24, 6.27±0.52, 8.85±0.68, 12.44±0.87 μg/mL）. The serum PEDF of type 2 diabetes mellitus （T2DM） patients was significantly higher than that of the NC group and elevated gradually with the progression of DN （F= 13.07, P〈0.05）. The urine PEDF levels of NC, DM, DN In, DNIWgroups were （4.98±0.21, 5.20±0.18, 6.29±0.46, 8.63±0.85 μg/mL）. The urine PEDF of T2DM patients was significantly higher than that of the NC group and elevated gradually with the progression of DN （F=20.52, P〈0.01）. Correlation analysis demonstrated thatserum and urine PEDF levels were positively correlated with UAER （r1=0.880, P〈0.01）; （r2=0.809, P〈0.01）. Conclusion： The serum and urine PEDF levels significantly increases in type 2 diabetic patients, and the magnitude of PEDF is related to the severity of diabetic nephropathy. The increase of PEDF may involve in the development of diabetic nephropathy. PEDF in serum and urine may play an important role in the early identification of diabetic nephropathy.