糖尿病患者不同蛋白尿水平血清血管内皮生长因子、肿瘤坏死因子α及脂联素的变化及其意义

Expression and clinical significance of VEGF,TNF-α,and APN in T2DM patients with various degrees of albuminuria

目的探讨糖尿病患者不同蛋白尿水平血清血管内皮生长因子(VEGF)、肿瘤坏死因子-α(TNF-α)及脂联素(APN)的变化及其意义。方法选取2型糖尿病(T2DM)患者75例为病例组,根据尿微量白蛋白(MA)水平将其分为3组。选取同期健康体检者23例作为对照组。测定各组血清VEGF、脂联素、血清TNF-α、MA及其他生化、人体测量指标。结果与对照组相比,T2DM组血清VEGF[(0.58±0.07)pg/m L]、TNF-α[(0.80±0.09)U/L]、脂联素[(16.457±1.90)mg/dl]水平均显著升高(P<0.05)。与正常蛋白尿组相比,微量蛋白尿组、临床肾病组血清VEGF、TNF-α、脂联素水平均升高,Alb、e GFR水平均降低(P<0.05)。与微量蛋白尿组相比,临床肾病组血清VEGF、TNF-α、脂联素水平更高,Alb、e GFR水平更低(P<0.05)。结论血清VEGF、TNF-α、脂联素可反映糖尿病肾病早期肾功能损伤,随着糖尿病肾病进展,呈逐渐增多趋势。TNF-α、脂联素是MA的独立危险因素。

Objective To explore the level and changes of vascular endothelial growth factor （ VEGF）, tumor necrosis factor - α （TNF -α）, and adiponectin （APN） in type 2 diabetic （T2DM） patients with various degrees of albuminuria. Methods Seventy - five T2DM patients （case group） and twenty -three healthy subjects （normal control group） were included in the present study. Ac- cording to microalbuminuria （MA）, T2DM patients were divided into three groups： MA 〈 30mg/L for normal albuminuria group （n = 27） ;30 mg/L ≤ MA 〈 300 mg/L for microalbuminuria group （n = 27） ; MA ≥ 300 mg/L for clinical renal disease group （ n = 21 ）. All cases were detected with VEGF, MA, TNF - α, APN, pre - albumin （PA） , blood glucose, urea nitrogen （ BUN）, serum creati- nine （ SCr）, plasma albumin （ ALB ） and urinary microalbuminuria （ MA ） , and so on. The renal function of cases was assessed by CKD - EPI formula. Plasma VEGF and APN levels were measured by ELISA method. TNF - α was measured by radioimmunoassay method. Results lasma VEGF, TNF -α and APN levels were significantly higher in the T2DM group compared to normal control group （ P 〈 0.05 ）. Compared with normal albuminuria group, VEGF, TNF - α and APN levels were significantly higher and ALB, eGFR were lower in microalbuminuria group and clinical renal disease group （ P 〈 0.05 ）. Multiple stepwise regression showed that TNF - α, APN were independent risk factors of MA. Conclusion This study suggests that VEGF, TNF - α, APN can reflect the early renal damage of T2DM, and along with the progress of T2DM, associate with the degree of kidney damage. TNF- α, APN are independent risk factors of MA.