糖尿病肾病患者血清瘦素水平变化与氧化应激的关系

Relationship between serum Leptin change and oxidative stress in diabetic nephropathy

目的 研究血清瘦素（Leptin）水平变化和氧化应激（OS）在糖尿病肾病（DN）发病中的可能作用,DN患者血清Leptin水平变化与OS的关系。方法 选择2014年6月～2015年6月在佳木斯大学第五临床医院治疗的2型糖尿病（DM）患者90例,依据尿白蛋白排泄率分为3组：正常白蛋白尿组（单纯DM组）、微量白蛋白尿组（早期DN组）、临床白蛋白尿组（临床DN组）,每组30例。选取同期我院体检健康者30例为正常对照组（对照组）。检测四组血清Leptin、丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）水平。分析DN患者血清Leptin水平与MDA、SOD、GSH-Px水平的相关性。观察给于DN组患者替米沙坦（telmisartan）治疗,80 mg/d,治疗4周患者血清Leptin、MDA、SOD、GSH-Px水平的变化。结果 临床DN组血清Leptin、MDA[（21.97±5.12）ng/ml、（21.86±3.42）nmol/m L]均明显高于早期DN组[（15.62±4.31）ng/m L、（16.75±2.98）nmol/m L],早期DN组血清Leptin、MDA明显高于单纯DM组[（10.16±3.07）ng/m L、（12.34±2.31）nmol/m L],临床DN组血清SOD、GSH-Px[（60.59±5.06）、（87.34±4.02）U/m L]均明显低于早期DN组[（72.78±6.32）、（103.29±5.75）U/m L],早期DN组SOD、GSH-Px明显低于单纯DM组[（83.46±6.97）、（114.58±6.84）U/m L],差异有高度统计学意义（P〈0.01）。DN患者血清Leptin与血清MDA水平呈明显正相关（r=0.685,P〈0.01）,与SOD、GSH-Px水平呈明显负相关（r=-0.597、-0.656,P〈0.01）。DN患者给予Telmisartan治疗后随着血清Leptin水平降低患者血清MDA水平降低,SOD、GSH-Px水平升高（P〈0.01）。结论 DM患者血清Leptin水平升高及所致的OS在DN的发病中发挥重要作用。

Objective To study the effect of serum Leptin change and oxidative stress in the development of diabetic nephropathy and to investigate the relationship between the serum leptin change and oxidative stress in the diabetic nephropathy. Methods 90 patients with type 2 diabetes mellitus were selected from June 2014 to June 2015 in the Fifth Clinical Hospital of Jiamusi University, and they were divided into three group acording to the urinary albumin excretion rat （UAER）： nomal albumin uria group （simple diabetes mellitus group）, microalbumin uria group （early dia- betic nephropathy group） and clinical albumin uria group clinical diabetic nephropathy group）,each group had 30 cases, were 30 cases of normal individuals with physical examination during the same period were as the control group （control group）. The Levels of serum Leptin, malondialdehyde （MDA）, superoxide dismulase （SOD） and glutathione peroxidase （GSH-Px） were measured in four groups.The relationship between the serum leptin Level and serum MDA, SOD,GSH-Px levels were analyzed in the patients with diabetic nephrophthy. The changes of serum Leptin, MDA, SOD and GSH-Px levels were investigated in the patients with diabetic nephrophthy after treatment with telmisartan 80 rag/d, for 4 weeks. Results The results showed that the serum Leptin and MDA levels in the clinical diabetic nephropathy group [（21.97＋ 5.12）ng/mL （21.86_＋3.42）nmol/mL] were significantly higher than those in the early diabetic nephropathy group [（15.62＋ 4.31）ng/mL, （16.75-＋2.98）nmol/mL], the serum Leptin and MDA levels in the early diabetic nephropathy group were significantly higher than those in the simple diabetes mellitus group [ （ 10.16 ±3.07） ng/mL, （ 12.34±2.31）nmol/mL], the serum SOD and GSH-Px levels in the clinical diabetic nephropathy group [（60.59±5.06）U/mL （87.34±4.02）U/mL] were significantly lower than those in the early diabetic mellitus group [（72.78±6.32）U/mL, （103.29±5.75）U/mL], the serum SOD and GSH-Px levels in the early diabetic nephropathy group were significantly lower than those in the simple diabetes mellitus group [（83.46±6.97）U/mL, （114.58±6.84）U/mL],the differences were statistically significant （P 〈 0.01）. A positive correlation was found between serum Leptin and serum MDA （r = 0.685,P 〈 0.01）, a negtive correlation was found between serum Leptin and serum SOD, GSH-Px （r = -0.597,-0.656,P 〈 0.01） in the patients with diabetic nephropathy. The levels of serum Leptin and MDA were significantly decreased, the levels of serum SOD and GSH-Px were significantly increased after treatment with telmisartan in the patients with diabetic nephropathy （P 〈 0.01）. Con- dusion The high serum level of Leptin and the increased oxidative stress might play an important role in the development of diabetic nephropathy.