不同尿蛋白排泄率的2型糖尿病患者血清多聚ADP核糖聚合酶的变化及其临床意义

Clinical significance of serum PARP in patients with type 2 diabetes and different level of urinary protein excretion rate

目的研究糖尿病慢性肾脏疾病（CKD）不同阶段患者血清多聚ADP核糖聚合酶（PARP）水平的变化及临床意义。方法收集T2DM患者195例，根据尿白蛋白／肌酐（UACR）水平，分为UACR〈30mg／g组、UACR30-300mg／g组、UACR〉300mg／g组，另选健康志愿者68名作为正常对照（NC）组。收集标本检测PARP、纤维蛋白原（Fg）、3硝基酪氨酸（3-NT）、单核细胞趋化蛋白-1（MCP-1）、TGF-β1水平，并行相关性分析及多元逐步回归分析。结果3组T2DM患者血清PARP均较NC组高E（56．07±14．05）vs（73．99±10．69）vs（86．18±11．23）vs（34．60±9．21）pg／ml，P〈0．01]。相关分析显示，血清PARP与UACR、Fg、3-NT、MCP-1、TGF-β1呈正相关（r=0．484、0．618、0．854、0．899、0．693，P〈0．05）。多元逐步回归分析显示，Fg、UACR是影响血清PARP的独立危险因素（P〈0．05），回归方程为YPARP=13．004＋3．693XFg＋0．02XUACR。结论T2DM患者血清PARP水平与CKD肾脏损伤有一定联系，可能成为早期诊断CKD的新型生物学标志物。PARP参与CKD肾脏损伤可能涉及氧化应激、慢性炎性反应、肾脏纤维化、纤溶系统紊乱等机制。

Objective To investigate the changes and clinical significance of serum PARP levels in T2DM patients with different stages of chronic kidney disease （CKD）. Methods A total of 195 patients with type 2 diabetes （T2DM） were enrolled in this study and divided into 3 groups according to the level of urinary albumin to creatinine ratio （UACR）：UACR〈30 mg/g group,UACR 30-300 mg/g group and UACR〉300 mg/g group. And 68 healthy volunteers were selected as the normal control group （NC group）. All the samples were collected and PARP, Fg, 3-NT, MCP-1 and TGF-β1 were measured. Correlation analysis and multiple stepwise regression analysis were performed. Results The serum PARP level were higher in the three patient groups than in NC group [-（56.07 ±14.05）vs （73.99±10. 69） vs（86. 18±11.23）vs（34. 60± 9.21） pg/ml, P〈0. 01]. The serum PARP was positively correlated with UACR,Fg, 3-NT, MCP-1 and TGF-β1 （r= 0. 484, 0. 618, 0. 854, 0. 899,0, 693, P〈0. 05）. Multiple stepwise regression analysis showed that UACR and Fg were the independent risk factors for serum PARP （P〈0.05） ,and the regression equation was YPARP =13. 004＋3. 693XFg＋0.02XUACR. Conclusion The level of serum PARP in T2DM patients is associated with CKD renal injury, which may become a new biological marker of early diagnosis of CKD. PARP may be involved in oxidative stress, chronicinflammatory response, renal fibrosis and fibrinolysis system disorder.