不同分期糖尿病肾病患者血HO-1和ox-LDL/β_(2)-GPI的变化及临床意义

Changes and Clinical Significance of Serum HO-1 and ox-LDL/β_(2)-GPI in Patients with Diabetic Nephropathy at Different Stages

目的探讨血清血红素氧合酶-1(HO-1)和氧化低密度脂蛋白/β_(2)-糖蛋白I(ox-LDL/β_(2)-GPI)在不同分期糖尿病肾病患者中的水平变化及可能临床意义。方法选取2018年1月-2019年1月邢台市人民医院收治的2型糖尿病患者70例作为研究对象,依据尿白蛋白/肌酐比值(ACR)分为尿蛋白阴性组(20例)、微量白蛋白尿组(25例)、显性蛋白尿组(25例),另选取同期我院体检中心的健康体检者20例作为健康对照组。比较四组血HO-1、ox-LDL/β_(2)-GPI、丙二醛(MDA)、同型半胱氨酸(Hcy)、ACR水平及阳性率,并分析各指标与ACR的关系。结果显性蛋白尿组、微量白蛋白尿组、尿蛋白阴性组血MDA、HO-1、ox-LDL/β_(2)、Hcy水平高于健康对照组(P<0.05),且随着肾病分期进展逐渐升高;显性蛋白尿组BUN、SCr高于微量白蛋白尿组、尿蛋白阴性组、健康对照组(P<0.05),其余指标比较,差异无统计学意义(P>0.05)。联合检测MDA、HO-1、ox-LDL/β_(2)-GPI、Hcy阳性率高于各指标单项检测阳性率(P<0.05)。Pearson相关性分析显示,血HO-1、MDA、ox-LDL/β_(2)-GPI、Hcy与ACR呈正相关(r=0.501、0.457、0.434、0.429,P<0.05)。结论氧化应激参与糖尿病肾病的发展,血HO-1、ox-LDL/β_(2)-GPI与ACR有良好相关性,为发现早期糖尿病肾病及病情进展的良好预测因子。联合检测MDA、HO-1、ox-LDL/β_(2)-GPI、Hcy可提高早期糖尿病肾病诊断的敏感性。

Objective To investigate the level changes and possible clinical significance of serum heme oxygenase-1(HO-1)and oxidized low density lipoprotein/β_(2)-glycoprotein I(ox-LDL/β_(2)-GPI)in patients with diabetic nephropathy at different stages.Methods A total of 70 patients with type 2 diabetes mellitus admitted to Xingtai People's Hospital from January 2018 to January 2019 were selected as the study subjects.According to urinary albumin/creatinine ratio(ACR),they were divided into urinary protein negative group(20 cases),microalbuminuria group(25 cases)and dominant proteinuria group(25 cases).At the same time,20 healthy subjects in the physical examination center of our hospital were selected as the health control group.The positive rates of HO-1,ox-LDL/β_(2)-GPI,MDA,Hcy and ACR levels in the four groups were compared,and the relationship between each index and ACR was analyzed by Pearson correlation analysis.Results The levels of MDA,HO-1,ox-LDL/β_(2) and Hcy in dominant proteinuria group,microalbuminuria group and urinary protein negative group were higher than those in healthy control group(P<0.05),and with the progression of renal disease stage gradually increased.The levels of BUN and SCr in dominant proteinuria group were higher than those in microalbuminuria group,urinary protein negative group and healthy control group(P<0.05),there was no significant difference in other indexes among the four groups(P>0.05).The positive rates of combined detection of MDA,HO-1,ox-LDL/β_(2)-GPI and Hcy were higher than those of single detection of each index(P<0.05).Pearson correlation analysis showed that blood HO-1,MDA,ox-LDL/β_(2)-GPI,Hcy were positively correlated with ACR(r=0.501,0.457,0.434,0.429,P<0.05).Conclusion Oxidative stress are involved in the development of diabetic nephropathy,and blood HO-1、ox-LDL/β_(2)-GPI has a good correlation with ACR,which is a good predictor of early diabetic nephropathy and its progression.Combined detection MDA、HO-1、ox-LDL/β_(2)-GPI、Hcy can improve the sensitivity of early diabetic nephropathy diagnosis.