MIF、TLR4、TNF-α水平在糖尿病肾病患者中的变化及其临床意义

The levels of MIF,TLR4,TNF-α in patients with diabetic nephropathy and its clinical significance

目的观察巨噬细胞移动抑制因子(MIF)、Toll样受体4(TLR4)、肿瘤坏死因子-α(TNF-α)水平在糖尿病肾病患者中的变化及其临床意义。方法选取2012年5月—2015年4月湖北省十堰市太和医院肾内科收治糖尿病肾病患者77例。按照尿微量白蛋白和肌酐的比值(尿A/C)分为2组,尿A/C≤300 mg/g为A组42例,尿A/C>300 mg/g为B组35例;另外选择同期进行健康体检者38例为C组。比较3组的临床与生化资料及MIF、TLR4、TNF-α水平,分析MIF、TLR4、TNF-α与糖尿病肾病患者有关临床指标之间的关系。结果 A组患者体质量指数(BMI)、收缩压(SBP)、糖化血红蛋白(HbA_(1c))、空腹血糖(FPG)分别为(26.78±3.46)kg/m^2、(137.43±10.11)mmHg、(8.81±0.87)%、(8.85±1.87)mmol/L,B组患者分别为(27.15±3.53)kg/m^2、(140.24±11.25)mmHg、(9.02±0.94)%、(8.94±1.91)mmol/L,明显高于C组的(23.43±3.01)kg/m^2、(122.04±9.55)mrnHg、(5.24±0.32)%、(5.18±0.53)mmol/L,而高密度脂蛋白胆固醇(HDL-C)低于C组,差异具有统计学意义(P<0.01);B组患者的舒张压(DBP)、三酰甘油(TG)、总胆固醇(TC)、血肌酐(SCr)、尿素氮(BUN)水平分别为(81.43±10.22)mmHg、(3.53±0.98)mmol/L、(5.83±0.99)mmol/L、(122.45±15.32)μmol/L、(7.88±2.01)mmol/L高于A组(P<0.01)。A组MIF、TLR4、TNF-仪分别为(143.21±12.32)ng/ml、(5.72±0.87)pg/ml、(26.98±5.33)pg/ml,B组分别为(147.44±13.45)ng/ml、(6.14±0.92)pg/ml、(28.14±6.21)pg/ml,均明显高于C组(113.53±10.43)pg/ml、(1.97±0.51)pg/ml、(18.45±4.35)pg/ml,差异具有统计学意义(P<0.01)。MIF与糖尿病肾病患者病程、HbA_(1c)、FPG、TG呈正相关(r=0.435、0.459、0.521、0.254,P<0.05~0.01),与HDL-C呈负相关(-0.231,P<0.05);TLR4与糖尿病肾病患者的SCr、CPR、尿蛋白、尿A/C呈正相关(r=0.873、0.901、0.957、0.676,P<0.01);血清TNF-α与糖尿病肾病患者病程及尿A/C呈正相关(r=0.197,P<0.05;r=0.254,P<0.01)。结论 MIF、TLR4、TNF-α在糖尿病肾病患者中存在高表达,可反映糖尿病肾病的损伤程度。

Objective To observe the changes and clinical significance of macrophage migration inhibitory factor（MIF）,Toll like receptor 4（TLR4） and tumor necrosis factor-a（TNF-α） levels in patients with diabetic nephropathy.Methods 77 cases of diabetic nephropathy were selected from the Department of internal medicine,Shiyan Taihe Hospital,Hubei Province from May 2012 to April 2015.According to the urine albumin and creatinine ratio（urinary A/C）,they were divided into 2 groups,urinary A/C less than or equal to 300 mg/g as group A with 42 cases,urinary A/C 〉300 mg/g as group 15（35 cases）;and chose 38 cases health examination at the same time as control group（group C）.The clinical and biochemical data of the 3 groups were compared with the levels of MIF,TLR4 and TNF-α,and the relationship between MIF,TLR4,TNF-a and clinical indexes of diabetic nephropathy were analyzed.Results Croup A patient＇s body mass index（BMI）,systolic blood pressure（SBP）,glycated hemoglobin（HbA1c）,fasting plasma glucose（FPG） were（26.78 ±3.46）kg/m^2,（137.43 ±10.11） mmHg,（8.81 ±0.87）%,（8.85 ± 1.87） mmol/L,respectively,and group B were（27.15 ±3.53） kg/m^2,（140.24 ±11.25） mmHg,（9.02 ± 0.94）%,（8.94±1.91） mmol/L,which significantly higher than the group C＇s（23.43 ±3.01） kg/m^2,（122.04 ±9.55） mmHg,（5.24 ±0.32）%,（5.18 ±0.53） mmol/L,while high density lipoprotein protein cholesterol（HDL-C） were lower than group C,the difference were statistically significant（P〈0.01）;group B patients＇ diastolic blood pressure（DBP）,triglyceride（TG）,total cholesterol（TC）,creatinine（SCr）,blood urea nitrogen（BUN） levels were（81.43 ± 10.22） mmHg,（3.53 ±0.98） mmol/L,（5.83 ±0.99） mmol/L,（122.45 ±15.32） μmol/L,（7.88 ±2.01） mmol/L,which were higher than group A（P〈0.01）.Group A＇s MIF,TLR4,TNF-αwere（143.21 ±12.32） ng/ml,（5.72±0.87） pg/ml,（26.98±5.33） pg/ml respectively,group B were（147.44 ±13.45） ng/ml,（6.14 ±0.92） pg/ml,（28.14 ±6.21） pg/ml respectively,which were significantly higher than group C＇s（113.53 ± 10.43） pg/ml,（1.97 ±0.51） pg/ml,（18.45 ±4.35） pg/ml,the difference were statistically significance（P〈0.01）.MIF and duration of diabetes patients with kidney disease,HbA1c,FPG,TG were positively correlated（r =0.435,r =0.459,r =0.521,r =0.254,P 0.05,P〈0.01）,and showed negative correlation with HDL-C（r =-0.231,P 0.05）;TLR4 positive correlated with diabetic nephropathy patients＇ SCr,CPR,urine protein A/C（r =0.873,r =0.901,r =0.957,r =0.676,P〈0.01）;serum TNF-α and course of patients with diabetic nephropathy and urine A/C was positively correlated（r =0.197,r = 0.254,P 0.05,P〈0.01）.Conclusion The levels of the MIF,TLR4,TNF-α in diabetic nephropathy patients with high expression,and correlated with diabetic nephropathy disease course.