2型糖尿病患者血清ChREBP水平与糖尿病肾病的相关性

Association of serum carbohydrate-responsive element-binding protein with diabetic kidney disease in patients with type 2 diabetes mellitus

目的探讨2 型糖尿病患者血清ChREBP 水平与糖尿病肾病的关系。方法选取2017 年1 月—2018 年1 月于吉林大学第二医院内分泌科确诊为2 型糖尿病的80 例患者,分为糖尿病肾病组[DN 组,24 h尿白蛋白排泄率(24 h UAER)≥ 30 mg/24 h]和单纯2 型糖尿病组(T2DM 组,24 h UAER<30 mg/24 h),每组40 例,从体检中心收集同期健康群众40 例作为对照组(NC 组)。采集研究对象的性别、年龄、病程、身高及体重等资料,计算体重指数。测定空腹血糖(FPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿素氮、血清肌酐(Scr)、空腹胰岛素(FINS)及24 h UAER,计算肾小球滤过率(eGFR)和稳态胰岛素评价指数(HOMA-IR)。采用酶联免疫吸附(ELISA)法检测血清中ChREBP、高迁移率族蛋白-1、TNF-α、IL-1β及IL-6 水平。结果血清ChREBP 水平DN 组最高,NC 组最低(P <0.05)。ChREBP 与eGFR 呈负相关(rs =-0.694,P =0.000);ChREBP 与24 h UAER、IL-1β、IL-6、TNF-α及HMG-1 呈正相关(r s =0.596、0.711、0.650、0.684 和0.515,P <0.05)。Logistic 回归分析显示,病程[OR=1.44,95% CI(1.10,1.87)]、HOMAIR[OR=2.22,95% CI(1.31,3.76)]、24 h UAER[OR=1.03,95% CI(1.00,1.06)]及ChREBP[OR=1.01,95%CI(1.00,1.03)]是糖尿病患者肾脏病变的独立危险因素(P <0.05)。结论 2 型糖尿病患者血清ChREBP 水平升高可能与糖尿病肾病的发生、发展相关。

Objective To explore the relationship between the serum levels of ChREBP with the development of diabetic kidney disease in patients with type 2 diabetes mellitus (T2DM). Methods A total of 80 patients with T2DM in the Department of Endocrinology of the Second Hospital of Jilin University were included. They were divided into two groups as: T2DM with DN group (DN, 24 hUAER≥30 mg/24 h, n = 40), T2DM without DN group (T2DM, 24 hUAER<30 mg/24 h, n = 40). In the same period, 40 healthy subjects were collected from the medical examination center as normal control group (NC, n = 40). Data including gender, age, duration of diabetes, height,weight, body mass index. Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea nitrogen (BUN), serum creatinine (Scr), fasting insulin (FINS), 24h urinary albumin excretion rate (24 hUAER) was determined. Estimated glomerular filtration rate (eGFR) and insulin resistance index (HOMA-IR) were calculated. The serum levels of ChREBP, HMG1 and inflammatory cytokines including TNF-α, IL-1β, IL-6 were determined by ELISA. Results ① The serum levels of ChREBP from high to low were DKD group, T2DM group and NC group (P = 0.000).② There was a negative correlation between ChREBP and eGFR (rs=-0.694, P < 0.001). There was a positive correlation between ChREBP and 24hUAER, IL-1β, IL-6, TNF-α, HMG-1 (r s=0.596, r s=0.711, r s=0.650, r s=0.684, r s=0.515, P < 0.05).③ Logistic regression analysis showed that duration of diabetes [OR=1.44,(95% CI 1.10 ~ 1.87)], HOMA-IR [OR=2.22,(95% CI 1.31 ~ 3.76)], 24hUAER [OR=1.03,(95% CI: 1.00 ~ 1.06)] and ChREBP [OR=1.01,(95% CI: 1.00 ~ 1.03)] were independent risk factors of diabetic kidney disease in T2DM. Conclusions The elevated of serum ChREBP in T2DM may be related to the occurrence and development of diabetic kidney disease.