糖尿病肾病患者血清和肽素、脂联素水平变化及其与肾动脉血流阻力指数的相关性

Changes of serum copeptin and adiponectin levels in patients with diabetic nephropathy and the correlation with renal artery resistance index

目的探讨糖尿病肾病(DN)患者血清和肽素、脂联素水平变化及其与肾动脉血流阻力指数(RI)的关系。方法选取2015年8月至2017年8月收治的2型糖尿病(T2MD)患者140例作为研究对象,根据24h尿清蛋白排泄率(UAER)分为3组,UAER<30mg/24h为单纯糖尿病组61例,UAER为30~300mg/24h为微量清蛋白尿组44例,UAER>300mg/24h为大量清蛋白尿组35例,另从体检中心选取年龄、性别匹配的体检健康者50例作为对照组,检测4组血清和肽素、脂联素水平,采用彩色多普勒超声取肾门处主动脉(MRA)、肾窦部的段动脉(SRA)、皮髓交界处的叶间动脉(IRA)检测收缩期峰值速度(PSV)、舒张末期血流速度(EDV),并计算阻力值(RI)。结果和肽素、脂联素水平在大量清蛋白尿组、微量清蛋白尿组、单纯糖尿病组、对照组中为逐渐降低趋势,4组差异具有统计学意义(P<0.05);MRA、SRA、IRA的PSV、EDV值在单纯糖尿病组、微量清蛋白尿组、大量清蛋白尿组中为逐渐降低趋势,RI为逐渐升高趋势,3组比较差异有统计学意义(P<0.05),单纯糖尿病组各级肾动脉的PSV、EDV、RI值与对照组比较,差异无统计学意义(P>0.05);和肽素、脂联素与各级肾动脉PSV、EDV呈负相关(P<0.05),与各级肾动脉RI值呈正相关(P<0.05)。结论DN患者血清和肽素、脂联素水平与各级肾动脉血流参数有关,与RI相关性尤为明显。

Objective To investigate the changes of serum copeptin and adiponectin levels in patients with diabetic nephropathy (DN) and the relationship with the renal artery resistance index (RI). Methods 140 patients with type 2 diabetes mellitus (T2MD) who were admitted during the period from August 2015 to August 2017 were selected as the subjects.According to the 24h urinary albumin excretion rate (UAER),they were divided into 3 groups,namely,the simple DM group (UAER<30 mg/24 h,61 cases),the microalbuminuria group (UAER of 30-300 mg/24 h,44 cases) and the macroalbuminuria group (UAER>300 mg/24 h,35 cases).Another 50 healthy people with matched age and gender were selected as the control group.The serum copeptin and adiponectin levels in the 4 groups were detected.The peak systolic velocities (PSV) and the end-diastolic velocities (EDV) of main renal artery (MRA) at the renal hilum,segmental renal artery (SRA) at renal sinus and interlobar renal artery (IRA) at the junction of cortex and medulla were detected by color Doppler ultrasound.The resistance index (RI) was calculated. Results Levels of copeptin and adiponectin in the macroalbuminuria group,the microalbuminuria group,the simple DM group and the control group showed a gradually decreasing trend,and the difference was statistically significant among the four groups (P<0.05).The PSV and EDV of MRA,SRA and IRA in the simple DM group,the microalbuminuria group and the macroalbuminuria group also showed a gradually decreasing trend while the RI showed a gradually increasing trend,and the differences were statistically significant among three groups (P<0.05).There was no significant difference in the PSV,EDV or RI of renal arteries at all levels between the macroalbuminuria group and the control group (P >0.05).Copeptin and adiponectin were negatively correlated with the PSV and EDV of renal arteries at all levels (P<0.05),positively correlated with the RI of renal arteries at all levels (P<0.05). Conclusion The levels of serum copeptin and adiponectin in patients with DN are related to the parameters of renal artery blood flow at all levels,and the correlation with RI is particularly obvious.