血清可溶性CD36与慢性肾脏病合并糖尿病患者临床指标的关系

Association of Serum Soluble CD36with Clinical Variables in Diabetic Patients with Chronic Kidney Diseas

目的探究血清可溶性CD36(sCD36)在合并/不合并糖尿病的慢性肾脏病(CKD)各期的表达水平及其与临床指标之间的相关性。方法纳入2014~2015年于四川大学华西医院肾脏内科住院并确诊为慢性肾脏病的患者161例,根据是否合并糖尿病分为两组:慢性肾脏病合并糖尿病(DM+CKD)组;慢性肾脏病非糖尿病(nonDM CKD)组。采用彩色多普勒超声诊断仪测定患者颈动脉内膜中层厚度(IMT)及是否合并粥样硬化斑块;收集患者空腹血清标本,采用ELISA法检测血清sCD36水平,根据CKD分期,分析随着肾脏疾病的进展,血清sCD36的表达状况。收集临床指标,分析其与sCD36的相关性。结果共纳入161例患者,其中DM+CKD组87例(54%),non-DM CKD组74例(46%)。两组间尿素氮(BUN)、血清肌酐(sCr)、估算肾小球滤过率(eGFR)、胱抑素C(Cys-C)、三酰甘油(TG)、胆固醇(Chol)、低密度脂蛋白胆固醇(LDL-C)、尿白蛋白/肌酐、IMT等指标差异无统计学意义(P>0.05)。与non-DM CKD组相比,DM+CKD组血清sCD36水平(U/L)较低(4.58±1.06vs.4.97±1.28,P<0.05),但进行CKD分期分层后,两组间血清sCD36差异不再有统计学意义(P>0.05)。在DM+CKD组中,血清sCD36与肾功能指标BUN、sCr、Cys-C呈负相关(r=-0.355,-0.336,-0.323;P<0.01),与eGFR呈正相关(r=0.399;P<0.01),而与TG、Chol、LDL-C、IMT无相关性(P>0.05);在non-DM CKD组中,sCD36与TG、Chol、LDL-C呈正相关(r=0.251,0.298,0.292;P<0.05),与Cys-C呈负相关(r=-0.287;P<0.05),而与eGFR、BUN、sCr、IMT无相关性(P>0.05)。随着CKD的进展,血清sCD36水平逐渐下降(P<0.05)。结论在糖尿病合并CKD患者中,血清sCD36水平与肾功能指标和CKD分期相关,而与脂类代谢指标无关。

Objective To investigate the levels of serum soluble CD36（sCD36）in patients of diabetes mellitus（DM）with chronic kidney disease（CKD）,and to analyze its correlation with clinical indicators.MethodsA total of 161 patients with CKD were enrolled in this study.The patients were divided into two groups according to whether they had DM or not：DM ＋CKD group and non-DM CKD group.The levels of carotid intima-media thickness（IMT）and the combination of atherosclerotic plaques were measured by color Doppler ultrasonography.Serum fasting serum samples were collected and serum sCD36 level was measured by ELISA.the status of serum sCD36 was analyzed with the progress of renal disease,and the correlation of sCD36 level with clinical indicators were analyzed.Results Among the 161 patients,87（54%）were DM＋CKD and 74（46%）were non-DM CKD.There was no significant difference in the levels of urea nitrogen（BUN）,serum creatinine（sCr）,estimated glomerular filtration rate（eGFR）,cystatin C（Cys-C）,triglyceride（TG）,cholesterol（Chol）,low density lipoprotein-chol（LDL-C）,urinary albumin/creatinine and IMT in the two groups（P〉0.05）.Compared with nonDM CKD group,the serum sCD36 level（U/L）in DM＋CKD group was lower（4.58±1.06 vs.4.97±1.28,P〈0.05）.In DM＋CKD group,serum sCD36 was negatively correlated with BUN,sCr and Cys-C（r=-0.355,-0.336,-0.323;P〈0.01）,and positively correlated with eGFR（r= 0.399;P〈0.01）,but not with TG,Chol,LDL-C or IMT（P〉0.05）.In non-DM CKD group,there was a positive correlation between sCD36 and TG,Chol and LDL-C（r= 0.251,0.298,0.292;P〈0.05）,and negatively correlated with Cys-C（r=-0.287;P〈0.05）,but not with eGFR,BUN,sCr or IMT（P〉0.05）.With the progress of CKD,serum sCD36 levels gradually decreased（P〈0.05）.Conclusion Serum sCD36 level is associated with renal function in the patients with DM complicated with CKD,but not with lipid indicators.