GLP-1及其受体激动剂与糖尿病肾病的相关性研究

Study on correlation between GLP-1 and its receptor stimulant with diabetic nephropathy

目的观察血清中血浆胰高血糖素样肽-1(GLP-1)在糖尿病肾病不同时期的水平变化,探讨其相关性及临床意义。方法选取2012年6月至2014年6月该院收治的糖尿病患者共180例,根据尿清蛋白排泄率(UAER)将其分为3组:UAER<20μg/min的58例,为无糖尿病肾病组(Ⅰ组);UAER为20~200μg/min的59例,为早期糖尿病肾病组(Ⅱ组);UAER>200μg/min的63例,为临床糖尿病肾病组(Ⅲ组)。选取同时期健康体检者共60例作为对照组。用酶免疫分析法测定各组空腹血清中GLP-1水平,分析其在糖尿病肾病不同阶段水平的变化及与疾病的相关性。结果各阶段糖尿病肾病组血浆自然对数变换后的高血糖素样肽-1水平(LnGLP-1水平)均低于对照组,且随着糖尿病肾病的加重,血浆LnGLP-1水平不断降低,差异有统计学意义(P<0.05)。多元逐步回归分析显示,全体受试对象血浆GLP-1水平与患者年龄、高密度脂蛋白胆固醇(HDL-C)显著相关,差异有统计学意义(P<0.05),而糖尿病肾病患者的血浆GLP-1水平与HDL-C相关,差异有统计学意义(P<0.05)。结论低水平血浆GLP-1可能是糖尿病肾病的危险因素,而高水平血浆GLP-1则可以减少糖尿病肾病患者大血管并发症的发生,GLP-1水平下降与糖尿病肾病的发病密切相关,可作为临床治疗的新靶点。

Objective To observe the change of levels of glucagon like peptide-1（GLP-1）in different stages of diabetes nephropathy（DN）patients,and to investigate their correlation and clinical significance.Methods A total of 180 cases of DN in our hospital from June.2012 to June.2014 were selected and divided into 3groups according to urinary albumin excretion rate（UAER）：58cases in the non-DN group（group Ⅰ,UAER20μg/min）,59 cases in the early DN group（group Ⅱ,UAER：20—200μg/min）and 63 cases in the clinical DN group（group Ⅲ,UAER200μg/min）.Meanwhile contemporaneous 60 persons undergoing the healthy physical examination were selected as the control group.The level of fasting serum GLP-1was measured by using the enzyme linked immunosorbent assay.The correlation between its level change in different stages of DN with the disease was analyzed.ResultsThe level of plasma LnGLP-1after logarithm transformation in different stages of DN groups was lower than that in the control group,moreover which was gradually decreased with DN was aggravated,the difference was statistically significant（P〈0.05）.The multivariate stepwise regression analysis showed the plasma GLP-1level in all subjects was significantly correlated with the age and HDL-C,the difference was statistically significant（P〈0.05）,and plasma HDL-C level was correlated with HDL-C in DN patients（P〈0.05）.Conclusion Low plasma GLP-1level might be a risk factor for DN.High plasma GLP-1level may reduce the occurrence of macrovascular complications in DN patients.The GLP-1level decrease is closely correlated with DN onset and can serve as the new target point of clinical treatment.