脂蛋白（a）对糖尿病肾病早期诊断和病情监测的意义

Value of serum lipoprotein （a） in diagnosing and monitoring early diabetic nephropathy

2型糖尿病患者256例根据尿微量白蛋白排泄率（UAER）分为正常白蛋白尿（NA）组、微量白蛋白尿（MA）组和临床肾病（CN）组，以108名健康体检者作为对照组。分别检测各组脂蛋白（a）、三酰甘油、总胆固醇（Tc）、低密度脂蛋白胆固醇（LDL—C）、胱抑素C、同型半胱氨酸等指标，进行单一因素方差分析。用Pearson相关分析分析脂蛋白（a）与UAER及。肾小球滤过率（eGFR）的相关性，用受试者工作特征（ROC）曲线评价脂蛋白（a）诊断糖尿病肾病（DN）的敏感度和特异度。结果显示，脂蛋白（a）水平从正常白蛋白尿组、微量白蛋白尿组到临床肾病组逐渐升高，在CN组明显升高（P〈0．05）。Pearson相关分析显示脂蛋白（a）与收缩压、rrC、胱抑素C、UAER呈正相关（P〈0．05），与空腹血糖、eGFR负相关（P〈O．05）。脂蛋白（a）的ROC曲线下面积为0．639，在最适切点为8．41mg／dl时，灵敏度、特异度分别为66．4％、55．9％。这些结果提示糖尿病患者脂蛋白（a）与UAER和eGFR有较好的相关性，脂蛋白（a）可以作为DN的一个病情蛤测指标．

According to urinary albumin excretion rates （ UAER）, 256 patients with type 2 diabete mellitus （T2DM） were divided into normal albuminuria （ NA ）, microalbuminuria （ MA ）, and clinical nephropathy （ CN ） groups while 108 healthy subjects as control group. The analysis of variance of single factor was applied to examine lipoprotein （ a）, triglyceride, total cholesterol （ TC）, low-density lipoprotein cholesterol （ LDL-C ）, cystatin C, and homocysteine. The correlations of lipoprotein （a） with urinary albumin excretion rate （ UAER ） and glomerular filtration rate （ eGFR ） were analyzed by Pearson correlation analysis. The sensitivities of lipoprotein （ a ） were evaluated in diagnosis of diabetic nephropathy （ DN ） by receiver operating characteristic curve. The results showed that lipoprotein （a） levels in NA, MA, and CN groups were gradually increased, with a significant increase in CN group （P 〈 0.05 ）. Pearson correlation analysis revealed that lipoprotein （a） was positively correlated with systolic pressure, TC, cystatin C, and UAER （ all P〈0.05 ） and negatively correlated with fasting blood glucose and eGFR （ P〈0.05 ）. The area under the ROC curve of lipoprotein （a） was 0. 639, with the sensitivity 66.4% and specificity 55.9% in the optimal cutoff value of S. 41 mg/dl. These results suggest that lipoprotein （a） may serve as an index for monitoring DN based on its better correlation with UAER and eGFR.