糖尿病肾脏病患者血清中脂联素与低氧诱导因子-1α水平的相关性

The correlation between serum adiponectin and hypoxia-inducible factor-1 in patients with diabetic nephropathy

目的探究糖尿病肾脏病患者血清中脂联素(adiponectin,ADPN)与低氧诱导因子-1α(hypixia inducible faotor,HIF-1α)水平的相关性及其临床意义。方法选取2019年8月27日至2019年12月29日武汉大学中南医院收治的糖尿病肾脏病(diabetic kidney disease,DKD)患者65例,DKD诊断标准参照2014年版《糖尿病肾脏疾病防治专家共识》,以仅有斜疝或单纯肠息肉而无其他症状的患儿作为对照组(CN组,23例);并根据尿蛋白排泄量(UAER)将糖尿病肾脏疾病组分为微量蛋白尿组37例,大量蛋白尿组10例,剩余18例为无蛋白尿组,符合糖尿病视网膜病变伴任何一期慢性肾脏病标准的DKD组归于视网膜病变组,但由于蛋白尿组中也有视网膜病变患者,故累计视网膜病变组为26例。大量蛋白尿组标准为尿白蛋白>300 mg/24 h或(+++)及以上,微量白蛋白尿组(标准为尿白蛋白<300 mg/24h或(++)及以下。采用酶联免疫吸附(ELISA)测得并分析两组及其亚组间血清ADPN和HIF-1α差异及相关性,探究其意义。结果糖尿病肾脏病组血清ADPN和HIF-1α均高于CN组,DKD组血清ADPN3808 ng/L(3625,4164)比CN组血清ADPN2954 ng/L(2439,3809),P<0.01;DKD组HIF-1α130.44 ng/L(119.50,143.08)比CN组HIF-1α98.32 ng/L(88.04,117.71),P<0.01。同时经过线性回归分析发现血清ADPN水平与HIF-1α呈直线正相关(R=0.961,b斜率=26.29,P<0.01)。血清ADPN和HIF-1α对DKD均有一定检测效能,分别为0.747和0.776,P<0.01。结论DKD中血清ADPN水平升高且与HIF-1α呈正相关,ADPN与HIF-1α可能存在的相关机制值得探索,血清ADPN可能通过与体内缺氧状态相联系共同参与DKD的病程进展。

Objective To investigate the correlation between adiponectin(ADPN)and hypoxia-inducible factor-1(HIF-1α)in the serum of diabetic nephropathy patients and its clinical significance.Methods A total of 65 diabetic nephropathy(DKD)patients admitted to Central South Hospital of Wuhan University from 2019.8.27 to 2019.12.29 were selected.Diagnostic criteria of diabetic nephropathy referred to Expert Consensus on Prevention and Treatment of Diabetic Nephropathy(2014 edition).The control group(CN)consisted of 23 patients with only oblique hernia or intestinal polyps without other symptoms.The diabetic nephropathy group was divided into macroalbuminuria subgroup(10 patients)and microalbuminuria subgroup(37 patients)according to the urinary protein excretion(UAER).The remaining 18 patients were non-albuminuria.The DKD group meeting the criteria of diabetic retinopathy with any stage of chronic kidney disease was included in the retinopathy group.However,since there was also a retinopathy subgroup in the proteinuria group,the cumulative number of retinopathy subgroup was 26 patients.The standard of the macroalbuminuria subgroup was urinary albumin>300 mg/24 h or(+++)or above,while the standard of the microalbuminuria subgroup was ualbumin<300 mg/24 h or(++)or below.The differences and correlations of serum adiponectin and HIF-1αbetween the two groups and their subgroups were analyzed to explore their clinical significance.Results Serum adiponectin and HIF-1αlevels in the diabetic nephropathy group were higher than those in CN group,and serum adiponectin in the DKD group was 3808 ng/L(3625,4164)vs.CN group 2954 ng/L(2439,3809)(P<0.01);serum HIF-1αin the DKD group was 130.44 ng/L(119.50,143.08)vs.CN group 98.32 ng/L(88.04,117.71)(P<0.01).At the same time,linear regression analysis showed that serum ADPN level was positively correlated with hif-1α,with R correlation coefficient=0.961,slope=26.29,and P<0.01.Moreover,the detection efficiency of serum adiponectin and hif-1 to DKD was 0.747 and 0.776,respectively,and P<0.01.Conclusion Serum adiponectin level is increased and positively correlated with HIF-1αin diabetic nephropathy,and serum adiponectin and HIF-1αmay have correlative mechanism worthy of exploration.Serum ADPN may be co-involved in the progression of diabetic nephropathy by relating to hypoxia in the body.