糖尿病肾病不同阶段与胎球蛋白A水平的相关性分析

Correlation between different stages of diabetic nephropathy and fetuin A levels

目的探讨2型糖尿病(T2DM)患者血清胎球蛋白A水平与糖尿病肾病(DN)不同阶段的相关性。方法选取2017年8月至2018年8月接受治疗的T2DM患者188例,根据其尿蛋白情况分为正常白蛋白尿(NA)组84例、微量白蛋白尿(MA)组74例和大量白蛋白尿(OA)组30例,另选同期健康体检者124例为正常对照(NC)组。检测计算四组对象的尿白蛋白与尿肌酐比值(ACR),血糖、血脂指标,以及血清胎球蛋白A、脂联素(ADP)、白细胞介素(IL)-1β水平,并进行比较分析。结果依NC组→NA组→MA组→OA组之序,研究对象胎球蛋白A、IL-1β水平和ACR依次递升,ADP水平依次递降,组间总体比较和两两比较差异均有统计学意义(P<0.01,P<0.05)。T2DM患者的胎球蛋白A水平与ACR、空腹血糖、餐后2h血糖、IL-1β水平及病程分别呈正相关(P均<0.01),与脂联素水平呈负相关(P<0.01);多元逐步回归分析显示,胎球蛋白A、IL-1β、ADP及病程是ACR的独立影响因素(P均<0.01)。结论胎球蛋白A水平与DN发展阶段之间存在关联;DN发展的风险随着胎球蛋白A水平的升高而升高;胎球蛋白A可能在DN发展的病理生理过程中扮演了重要角色。

Objective To investigate the relationship between serum fetuin A level and different stages of diabetic nephropathy(DN) in patients with type 2 diabetes mellitus(T2 DM).Methods A total of 188 patients with T2 DM receiving treatment from August 2017 to August 2018 were enrolled and divided into normal allbuminuria group(NA group,n=84),microalbuminuria group(MA group,n=74),and over albuminuria group(OA group,n=30) according to their urinary protein levels.During the same period,124 healthy persons were served as normal control group(NC group).The levels of urinary albumin-to-creatinine ratio(ACR),blood glucose,lipid profiles,fetuin A,adiponectin(ADP) and interleukin-1β(IL-1β) were measured and compared among four groups.Results In the order of NC group,NA group,MA group and OA group,the levels of serum fetuin A,IL-1β and urinary ACR increased in turn,and ADP level decreased in turn,and there were statistical differences in overall comparison and each pairwise comparison among four groups(P<0.01,P<0.05).The level of fetuin A was positively correlated with ACR,fasting blood glucose,2 h postprandial blood glucose,IL-1β and disease course(all P<0.01),respectively,while negatively correlated with ADP level in T2 DM patients(P<0.01).Multivariate stepwise regression analysis showed that fetuin A,IL-1β,ADP and disease course were the independent influencing factors of ACR(all P<0.01).Conclusions There is a correlation between Fetuin-A level and DN development stage.The risk of DN development increases with Fetuin-A level increasing.Fetuin-A may play an important role in the pathophysiological process of DN.