2型糖尿病患者空腹血糖、血脂、APN及VEGF与氧化应激的相关性

Relationship of Fasting Blood Glucose,Blood Lipid,Serum APN and VEGF levels with Oxidative Stress in Patients with Type 2 Diabetic Nephropathy

目的:探讨2型糖尿病肾病(DN)患者空腹血糖(FPG)、血脂、脂联素(APN)、血管内皮生长因子(VEGF)与氧化应激的相关性。方法:120例2型糖尿病(T2DM)患者,依据24 h尿白蛋白(ALB)排泄率(UAER)均分为T2MD组(UAER<20μg/min)、微量ALB尿组(UAER 20μg/min≤~<200μg/min)、大量ALB尿组(RAER≥200μg/min),另选取同期健康体检者40例为对照组;所有受试者与入院或体检当日抽取空腹静脉血,分离血清,采用全自动血生化仪测定总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),高压液相法测定糖化血红蛋白(Hb Alc);采用葡萄糖氧化酶法测定空腹血糖(FPG),ELISA法测定血清β2-微球蛋白(β2-MG)、APN、VEGF,酶联免疫定量法测定血清同型半胱氨酸(Hcy),免疫比浊法测定血清光抑素C(Cys C),比色法测定血清丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD);留取受试者清晨尿液标本,采用放射免疫分析法测定UAER;采用直线相关分析T2DM患者血清APN、VEGF、FPG、血脂与MDA、GSH-Px、SOD的相关性。结果:与对照组比较,3组DN患者Hb Alc、FPG、UAER、β2-MG、Cys C、Hcy、VEGF及MDA均升高,GSH-Px、SOD降低(P<0.05);3组DN患者血清FPG、UAER、β2-MG、Cys C、Hcy及VEGF及MDA水平随尿ALB水平增加而逐渐升高,APN逐渐降低(P<0.05),大量ALB尿组GSHPx、SOD低于T2MD组和微量ALB尿组(P<0.05);T2DM患者血清APN与MDA呈负相关(r=-0.479,P<0.05),与GSH-Px、SOD呈正相关(r=0.406,0.359,P<0.05);血清VEGF与MDA呈正相关(r=0.571,P<0.01),与GSH-Px、SOD呈负相关(r=-0.446,-0.454,P<0.05);FPG、血脂与MDA呈正相关(r=0.491,r=0.644,P<0.01),与GSH-Px、SOD呈负相关(r=-0.540,-0.836;r=-0.399,-0.492,P<0.05)。结论:T2MD合并DN患者血清FPG、血脂、APN及VEGF水平与机体氧化应激具有显著相关性,其水平变化提示T2MD并发DN的可能。

Objective： To investigate the relationship of fasting blood glucose, blood lipid, serum adiponectin （APN） and vascular endothelial growth factor （VEGF） levels with oxidative stress in type 2 diabetic nephropathy （DN） patients. Methods： A total of 120 patients type 2 diabetes mellitus （T2DM） patients were included, on the basis of 24 h urinary protein excretion rate （UAER）, patients were divided into T2MD group （UAER 〈20 μg/min, group A）, microalbuminuria group （20 μg/min ≤ UAER 〈 200 μg/min, group B） , macroalbuminuria group （ RAER ≥ 200 μg/min, group C）, and 40 eases of healthy volunteers were selected as control group. All subjects were taken fasting peripheral venous blood, total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C） and high density lipoprotein cholesterol （HDL-C） were measured by automatic blood biochemical ana- lyzer, and glycosylated hemoglobin （HbAlc） was determined by high pressure liquid chromatography. Fasting blood glucose was measured by glucose oxidase method （FPG）. Serum 132-microglobulin （132- MG）, APN, VEGF were detected by ELISA. Serum homoeysteine （Hey） were determined by enzyme-linked immunosorbent assay, Serum CysC were measured by immunoturbidimetry. Serum malondialdehyde （ MDA）, glutathione peroxidase （GSH-Px） and superoxide dismutase （SOD） were determined by colorimetry. The urine samples were collected from the subjects in the early morning, and UAER was measured by radioimmunoassay. The linear correlation analysis was employed to detect the correlation of serum APN, VEGF, FPG, blood lipid and MDA, GSH-Px, SOD in T2DM patients. Results： Compared with the control group, HbAle, FPG, UAER, 132-MG, CysC, Hey, VEGF and MDA were all increased in groups A, B and C, and GSH-Px and SOD decreased （ P 〈 0.05 ）. The levels of serum FPG, UAER, [~2-MG, CysC, Hey, VEGF and MDA increased gradually with the in- crease of urinary ALB level （ P 〈 0.05 ）. GSH-Px and SOD levels of group C were lower than groups A and B （ P 〈 0.05 ）. serum APN was negatively correlated with MDA （ r = - 0.479, P 〈 0.05 ）, and SOD was positively correlated with GSH-Px （ r = 0. 406, = 0. 359, P 〈 0. 05 ） ; the serum VEGF was positively correlated with MDA （r =0. 571, P 〈0. 01 ）, and negatively correlated with GSH-Px, SOD （r = -0. 446, - 0. 454, P 〈 0.05 ）. FPG and blood lipid was positively correlated with MDA （ r = 0.491, r =0. 644,P 〈0.01 ） ,and negatively correlated with GSH-Px, SOD（r = -0.540, -0. 836;r = -0. 399, - 0.492,P 〈 0.05 ）. Conclusions： FPG, blood lipid and the levels of serum APN and VEGF in pa- tients with T2MD complicated with DN are significantly correlated with oxidatie stress, and their level changes suggest the possibility of T2MD complicated with DN.