2型糖尿病肾病患者血清胎盘生长因子水平及其影响因素分析

Analysis of serum placental growth factor levels and influencing factors in type 2 diabetic nephropathy

目的观察2型糖尿病肾病(T2DN)不同分期血清胎盘生长因子(PIGF)的变化水平,探讨血清PIFG与影响因素的关系。方法选取2016年1月-2018年5月于内蒙古医科大学附属医院住院经肾活检诊断为T2DN患者90例,按尿白蛋白排泄率分为正常白蛋白尿组、早期糖尿病肾病组和临床糖尿病肾病组,并选取同期健康体检者作为对照组。比较各组血清PIFG水平的变化情况,同时分析患者血清PIFG与各参数的关系。结果正常白蛋白尿组、早期糖尿病肾病组和临床糖尿病肾病组的FBG、2hPG、BUN、CRP和HbA1c水平较对照组升高(P<0.05),Hb较对照组降低(P<0.05);早期糖尿病肾病组和临床糖尿病肾病组Scr、BUN和CRP含量水平较正常白蛋白尿组升高(P<0.05),Hb水平较正常白蛋白尿组降低(P<0.05);临床糖尿病肾病组的Scr、BUN、CRP和UAER较早期糖尿病肾病组均升高(P<0.05),Hb水平较早期糖尿病肾病组降低(P<0.05);常白蛋白尿组、早期糖尿病肾病组和临床糖尿病肾病组的PIGF水平均高于对照组(P<0.05)。早期糖尿病肾病组血清PIGF高于正常白蛋白尿组(P<0.05),临床糖尿病肾病组血清PIGF高于早期糖尿病肾病组(P<0.05)。血清PIGF水平与患者病程、FBG、2hPG、Scr、BUN、CRP、UAER和HbA1c呈正相关(r=0.433、0.372、0.374、0.722、0.384、0.301、0.861和0.492,P<0.05),与Hb、Alb呈负相关(r=-0.639和-0.353,P<0.05)。对血清PIGF水平影响从大到小依次为HbA1c、UAER、FBG及Sc(rP<0.05)。结论T2DN患者尤其是临床糖尿病肾病期患者血清PIFG的水平升高,同时血清PIFG与Scr、UAER、FBG和HbA1c有关,提示血清PIFG参与T2DN的发病过程。

Objective To investigate the serum placental growth factor levels in different stages of type 2 diabetic nephropathy and to analyze the relationship among the influencing factors. Methods A total of 90 type 2 diabetic nephropathy patients were diagnosed by renal biopsy admitted to the affiliated hospital of Mongolia medical university between January 2016 and May 2018 were enrolled in this study. According urinary albumin excretion rate (UAER), the type 2 diabetic nephropathy were divided into three group: normal albuminuria (A group, n = 30, UAER<30 mg/24 h);early diabetic nephropathy (B group, n = 30, 30 ~ 300 mg/24 h);clinical diabetic nephropathy (C group, n = 30, UAER>300 mg/24 h), and 30 healthy people acted as the control. The serum placental growth factor of three groups were compared and the correlation between each index and placental growth factor was analyzed. Results The levels of fasting blood glucose (FBG), postprandial blood glucose (2hPG), urea nitrogen (BUN), C-reactive protein (CRP) and glycosylated hemoglobin (HbA1c) in normal albuminuria group, early diabetic nephropathy group and clinical diabetic nephropathy group were higher than those in control group (P < 0.05). FBG, 2 hPG, TG, Scr, Hb, BUN and CRP in the disease group were higher than those in the normal albuminuria group (P < 0.05);FBG, 2 hPG, Scr, BUN, CRP, UAER and HbA1c in the clinical diabetic nephropathy group were higher than those in the early diabetic nephropathy group (P < 0.05). Serum PLGF levels were positively correlated with course of disease, FBG, 2 hPG, Scr, BUN, CRP, UAER and HbA1c (r = 0.433, 0.372, 0.374, 0.722, 0.384, 0.301, 0.861 and 0.492, P < 0.05), negatively correlated with Hb and Alb (r = 0.639 and -0.353, P < 0.05). The influence of serum PLGF level was HbA1c, UAER, FBG and Scr (P < 0.05). Conclusions Serum concentration of placental growth factor in type 2 diabetic nephropathy especially clinical diabetic nephropathy patients increases, meanwhile PLGF is correlated with Scr, UAER, FBG and HbA1c, suggesting placental growth factor is involved in the pathogenesis of type 2 diabetic nephropathy.