糖尿病肾病患者合并动脉粥样硬化危险因素分析

Risk factors of atherosclerosis in diabetic kidney disease

目的探讨糖尿病肾病(diabetic kidney disease,DKD)患者动脉硬化程度及相关影响因素。方法选择DKD患者60例,分为3组,分别为慢性肾脏病(chronic kidney disease,CKD)1~2期、3~4期、5期未透析患者,每组各20例,同时选择20例年龄、性别与DKD患者匹配的健康成年人作为对照组。测定血清丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(serum malondialdehyde,SOD)、髓过氧化物酶(myeloperoxidase,MPO)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-1β(interleukin-1β,IL-1β)、氧化低密度脂蛋白(oxidized low-density lipoprotein,ox-LDL)。应用B超测量计算双侧颈总动脉内膜-中层厚度(intima-medial thickness,IMT)、颈动脉斑块(carotid plaques,PS)、弹性指数(pressure-strain elastic modulus,Ep)、僵硬指数(stiffness index,SI),比较各组间临床生化及超声指标水平,并分析动脉粥样硬化的相关危险因素。结果DKD患者具有较高的全段甲状旁腺素(intact parathormone,iPTH)、血尿酸(serum uric acid,SUA)、C反应蛋白(C reactive protein,CRP)、MPO、MDA、ox-LDL、SOD、IL-6、IMT、PS、Ep、SI和较低的血红蛋白(hemoglobin,HB)、白蛋白(albumin,ALB)、总胆红素(total bilirubin,TBIL),与对照组相比,差异均有统计学意义(P<0.05)。在单变量分析中,IMT与iPTH、SUA、CRP、MPO、MDA、IL-6、ox-LDL呈正相关,Ep与iPTH、SUA、MPO、MDA、IL-6、ox-LDL呈正相关,SI与MPO、MDA、ox-LDL呈正相关,IMT、Ep、SI均与HB、ALB、TBIL呈负相关,差异均有统计学意义(P<0.05)。动脉粥样硬化组具有较高的iPTH、SUA、CRP、MPO、MDA、SOD、IL-6、ox-LDL、IMT、Ep、SI和较低的HB、ALB、TBIL,与非动脉粥样硬化组相比,差异均有统计学意义(P<0.05)。结论DKD患者动脉粥样硬化与传统和非传统危险因素密切相关,增加的超氧化物歧化酶水平可能表明人的抗动脉粥样硬化能力代偿性增强。

Objective To explore the degree of arteriosclerosis and related influencing factors in patients with diabetic kidney disease(DKD).Methods This study included 60 DKD patients with CKD stage 1-5(20 CKD 1-2,20 CKD 3-4,20 CKD 5 predialysis patients)and 20 age-and sex-matched controls.Serum malondialdehyde(MDA),superoxide dismutase(SOD),myeloperoxidase(MPO),interleukin-6(IL-6),interleukin-1β(IL-1β),oxidized low-density lipoprotein(ox-LDL)were measured.Carotid mean intima-medial thickness(IMT),carotid plaques(PS),pressure-strain elastic modulus(Ep)and stiffness index(SI)were measured by B-mode ultrasonography.The levels of clinical biochemical and ultrasound indexes were compared among the groups,and the related risk factors of atherosclerosis were analyzed.Results DKD patients had higher intact parathormone(iPTH),serum uric acid(SUA),CRP,MPO,MDA,ox-LDL,SOD,IL-6,IMT,PS,Ep,SI and lower hemoglobin(HB),albumin(ALB),total bilirubin(TBIL)compared to controls,and all differences were statistically significant(P<0.05).In univariate analyses,IMT positive correlation with iPTH,SUA,CRP,MPO,MDA,IL-6,ox-LDL,Ep positive correlation with iPTH,SUA,MPO,MDA,IL-6,ox-LDL,SI positive correlation with MPO,MDA,ox-LDL.IMT,Ep,SI all inverse correlation with HB,ALB,TBIL,and all differences were statistically significant(P<0.05).Atherosclerosis patients had higher iPTH,SUA,CRP,MPO,MDA,SOD,IL-6,ox-LDL,IMT,Ep,SI and lower HB,ALB,TBIL compared to non-atherosclerotic patients,all differences were statistically significant(P<0.05).Conclusion Atherosclerosis in DKD patients is strongly associated with traditional and non-traditional risk factors,and increased SOD levels may indicate that human anti-atherosclerotic ability compensatory enhancement.