血清chemerin、C反应蛋白及白介素6与糖尿病肾病的相关性研究

Correlation between serum levels of chemerin, C reactive protein, interleukin-6 and diabetic nephropathy

目的:探讨糖尿病肾病患者血清chemerin、高敏C反应蛋白(hs-CRP)、白介素6(IL-6)水平的变化及其临床意义。方法:2013年1月—2014年8月在我院住院的2型糖尿病患者180例,根据尿白蛋白/肌酐比(ACR)分为正常白蛋白尿组(NA组)、微量白蛋白尿组(MA组)、大量白蛋白尿组(CA组)3个亚组,另选健康体检者30名为正常对照组(NC组)。检测各组血清空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、稳态模型评估的胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肌酐(Cr)、尿ACR、hs-CRP、IL-6、chemerin等指标,并分析其相关性。结果 :NA组54例,MA组66例,CA组60例。2型糖尿病肾病患者血清chemerin、CRP、IL-6显著高于健康对照组(均P<0.05);chemerin、hs-CRP、IL-6水平3组比较差异具有统计学意义,CA组、MA组与NA组比较均显著升高(P<0.05)。简单直线相关分析显示:ACR与chemerin、hs-CRP、IL-6、Hb A1c、HOMA-IR、TG、Cr、收缩压(SBP)、病程呈正相关(r=0.62、0.58、0.59、0.47、0.45、0.52、0.54、0.53、0.56)(均P<0.05);与HDL-C呈负相关(r=-0.44,P<0.05)。多元逐步回归分析显示,Cr、hs-CRP、IL-6、chemerin以及病程是影响ACR的主要因素。结论 :血清chemerin、CRP、IL-6参与机体的炎症反应,并与ACR密切相关。chemerin、hs-CRP、IL-6可能通过调节脂肪细胞生成、胰岛素抵抗及炎症、内皮细胞损伤等机制参与糖尿病肾病的发生和发展。

Objective To investigate the change in serum levels and clinical significance of chemerin, high sensitivity C reactive protein（hs-CRP） and interleukin-6（IL-6）in patients with diabetic nephropathy（DN）. Methods One hundred and eighty patients with diabetes mellitus from Jan. 2013 to Aug.2014 were enrolled in this study. Patients were categorized into normal albuminuria group（NA group）, mild albuminuria group（MA group）, and massive albuminuria group（CA group） according to the results of urinary albumin / creatinine ratio（ACR）. Thirty healthy people were served as normal controls（NC group）. Serum fasting blood glucose（FBG）, glycosylated hemoglobin（Hb A1c）, homeostasis model assessment of insulin resistance（HOMA-IR）, triglyceride（TG）, total cholesterol（TC）, low density lipoprotein cholesterol（LDL-C）, high density lipoprotein cholesterol（HDL-C）, creatinine（Cr）, urinary ACR, hs-CRP, IL-6, chemerin and other indices were measured. Results There were 54 patients in NA group, 66 in MA group, and 60 in CA group. Serum levels of hs-CRP, IL-6 and chemerin were significantly higher in subjects with DN than in healthy control group（all P0.05）. Levels of chemerin, hs-CRP, and IL-6 differed between the 3 groups, and levels of chemerin, hs-CRP and IL-6were significantly higher in CA and MA groups than in NA group（P0.05）. Linear correlation analysis showed that ACR was positively correlated with chemerin, IL-6, CRP, Hb A1 c,HOMA-IR, TG, Cr, systolic blood pressure（SBP）and duration of diabetes（r=0.62, 0.58, 0.59, 0.47, 0.45, 0.52, 0.54, 0.53, 0.56, all P0.05）, and negatively correlated with HDL-C（r =-0.44, P〈0.05）. Multivariate stepwise regression analysis indicated that Cr, hs-CRP, IL-6, chemerin and duration of diabetes were independent determinants for ACR（ P0.05 or P0.01）. Conclusions Serum chemerin, hs-CRP and IL-6 were involved in the inflammatory response, which were closely related with ACR. Chemerin, hs-CRP, and IL-6 might be involved in the occurrence and development of DN by regulating fat cell generation, insulin resistance,inflammation and endothelial cell injury. Combined determination of hs-CRP, IL-6 and chemerin could be of important clinical significance in early diagnosis of DN.