Vaspin与2型糖尿病肾病的相关性研究

Correlation Between Vaspin and Nephropathy in Patients With Type 2 Diabetes Mellitus

目的探讨2型糖尿病(T2DM)患者血清中脂肪特异性丝氨酸蛋白酶抑制剂Vaspin与糖尿病肾病(DN)的关系。方法选取2013年11月—2014年2月秦皇岛市第三医院内分泌科住院的T2DM患者94例,根据24 h尿清蛋白排泄率(UAER)分为糖尿病(DM)组(UAER≤20μg/min)和DN组(UAER>20μg/min)。选取同期该院50例健康体检者为对照组。测定血清Vaspin及空腹血糖(FBG)、空腹胰岛素(FINS)、血脂、糖化血红蛋白(Hb A1c)、尿素氮(BUN)、肌酐(Cr)水平,采用稳态模型评估胰岛素抵抗指数(HOMA-IR),分析血清Vaspin与各指标之间的相关性,并对T2DM发生DN的影响因素进行Logistic回归分析。结果 DN组血清Vaspin水平低于DM组、高于对照组,DM组高于对照组,差异均有统计学意义(P<0.001)。DM组Vaspin水平与三酰甘油(TG)、FBG、Hb A1c、ln FINS、ln HOMA-IR、高密度脂蛋白胆固醇(HDL-C)相关(r=0.239、0.521、0.593、0.320、0.225、-0.357,P<0.05),DN组Vaspin水平与FBG、ln FINS、ln HOMA-IR相关(r=-0.532、-0.276、-0.239,P<0.05)。Logistic回归分析显示Vaspin〔OR=0.59,95%CI(0.48,0.92)〕、Hb A1c〔OR=1.75,95%CI(1.33,2.31)〕、BMI〔OR=4.83,95%CI(1.17,19.95)〕、ln HOMA-IR〔OR=1.36,95%CI(1.08,1.73)〕为DN的危险因素。结论胰岛素抵抗与低Vaspin水平是DN的危险因素,低Vaspin水平可作为DN的预测指标。

Objective To investigate the correlation between Vaspin in patients with type 2 diabetes mellitus（ T2DM）and diabetic nephropathy（ DN）. Methods We enrolled 94 T2 DM patients who were admitted into the Department of Endocrinology of the Third Hospital of Qinhuangdao from November 2013 to February 2014. According to 24 h urinary protein excretion rate（ UAER）,the patients were divided into two groups： DM group（ UAER≤20 μg / min） and DN group（ UAER 20 μg / min）. We also enrolled 50 healthy controls from the hospital in the same period as control group. The levels of Vaspin,FBG,FINS,blood fat,Hb A1 c,BUN and Cr were determined. Hemostasis model was employed to evaluate HOMA-IR,and the correlations between Vaspin and other indicators were investigated. Logistic regression analysis was also conducted to investigate the influencing factors for DN in T2 DM patients. Results For Vaspin level,DN group was lower（ P 0. 001） than DM group,DN group was higher（ P 0. 001） than control group,and DM group was higher（ P 0. 001） than control group.In DM group,Vaspin level was correlated with TG,FBG,Hb A1 c,ln FINS,ln HOMA-IR and HDL-C（ r = 0. 239,0. 521,0. 593,0. 320,0. 225,-0. 357; P 0. 05）; in DN group,Vaspin level was correlated with FBG,ln FINS,ln HOMA-IR（ r =-0. 532,-0. 276,-0. 239; P 0. 05）. The Logistic regression analysis showed that Vaspin 〔OR = 0. 59,95% CI（ 0. 48,0. 92） 〕,Hb A1c〔OR = 1. 75,95% CI（ 1. 33,2. 31） 〕,BMI 〔OR = 4. 83,95% CI（ 1. 17,19. 95） 〕 and ln HOMA-IR 〔OR = 1. 36,95% CI（ 1. 08,1. 73） 〕 were risk factors for DN. Conclusion Insulin resistance and low Vaspin level are risk factors for DN,and low Vaspin level can be used as a predictive indicator for DN.