糖尿病肾病患者血清MMP-2、MMP-9水平与血管钙化的关系

The expression levels of MMP-2,MMP-9 in serum of patients with diabetic nephropathy and their correlation with vascular calcification

目的探讨糖尿病肾病患者血清基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)水平与血管钙化的关系。方法收治的糖尿病肾病患者178例,分为糖尿病肾病未钙化组92例、糖尿病肾病钙化组86例,同期选择门诊正常体检者87例为对照组,测定3组血肮酐(Scr)、血磷(P3+)、血钙(Ca2+)、MMP-2、MMP-9、甲状旁腺激素(PTH)、碱性磷酸酶(ALP)、超敏C-反应蛋白(hs-CRP)水平。结果糖尿病肾病钙化组MMP-2水平高于糖尿病肾病未钙化组和对照组,糖尿病肾病未钙化组MMP-2水平高于对照组;糖尿病肾病钙化组MMP-9水平低于糖尿病肾病未钙化组和对照组,糖尿病肾病未钙化组MMP-9水平低于对照组,差异均有统计学意义(P<0.05);糖尿病肾病钙化组Scr、P3+、Ca2+、PTH、ALP、hs-CRP水平高于糖尿病肾病未钙化组和对照组,糖尿病肾病未钙化组Scr、P3+、Ca2+、PTH、ALP、hs-CRP水平高于对照组,差异有统计学意义(P<0.05);MMP-2与Scr、P3+、Ca2+、PTH、ALP、hs-CRP呈正相关,MMP-9与Scr、P3+、Ca2+、PTH、ALP、hs-CRP呈负相关,差异有统计学意义(P<0.05);MMP-2、MMP-9、Ca2+、PTH均为糖尿病肾病发生血管钙化的危险因素(P<0.05);MMP-2、MMP-9 ROC曲线下面积(AUC)相近(P>0.05),两者诊断糖尿病肾病合并血管钙化的灵敏度、特异度相近(P>0.05)。结论MMP-2高表达、MMP-9低表达能加速糖尿病患者肾脏损伤程度,加剧血管钙化;MMP-2、MMP-9、Ca2+、PTH可能为糖尿病肾病发生血管钙化的危险因素,MMP-2、MMP-9可作为判定糖尿病肾病合并血管钙化的生物学标志物,值得推广应用。

Objective To investigate the correlation between the serum levels of MMP-2,MMP-9 and vascular calcification in patients with diabetic nephropathy.Methods A total of 178 patients with diabetic nephropathy were divided into vascular calcification group(n=92)and non-vascular calcification group(n=86),at the same time,the other 87 health subjects were enrolled as control group.The levels of Scr,P,Ca,MMP-2,MMP-9,PTH,ALP and hs-CRP were detected and compared among the three groups.Results The levels of MMP-2 in vascular calcification group were significantly higher than those in non-vascular calcification group and control group,however,the levels of MMP-9 in vascular calcification group were significantly lower than those in non-vascular calcification group and control group,moreover,the levels of MMP-9 in non-vascular calcification group were significantly lower than those in control group(P<0.05).In addition the levels of Scr,P,Ca,PTH,ALP,and hs-CRP in vascular calcification group were significantly higher than those in non-vascular calcification group and control group,which in non-vascular calcification group were significantly higher than those in control group(P<0.05).Moreover MMP-2 was positively correlated with Scr,P,Ca,PTH,ALP and hs-CRP,however,MMP-9 was negatively correlated with Scr,P,Ca,PTH,ALP and hs-CRP(P<0.05).MMP-2,MMP-9,Ca and PTH were risk factors for vascular calcification in patients with diabetic nephropathy(P<0.05).The area under the ROC curve(AUC)of MMP-2 and MMP-9 was similar(P>0.05),which suggested that the sensitivity and specificity of the two indexes in diagnosis of diabetic nephropathy with vascular calcification were similar(P>0.05).Conclusion The high expression of MMP-2 and low expression of MMP-9 can accelerate the severity of renal damage in patients with diabetes mellitus,which can exacerbate vascular calcification.MMP-2,MMP-9,Ca and PTH may be the risk factors for vascular calcification in patients with diabetic nephropathy,thereby,MMP-2 and MMP-9 may be regarded as the biological markers in diagnosis of diabetic nephropathy with vascular calcification,and it is worthy of clinical application.