2型糖尿病患者血清sKlotho、NGAL、IL-6和IL-18表达及意义

Expression and significance of serum sKlotho,NGAL,IL-6,IL-18 in diabetic patients

目的研究2型糖尿病患者血清分泌型Klotho(sKlotho)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、白细胞介素-6(IL-6)、白细胞介素-18(IL-18)的水平,分析其相关性。方法选取178例2型糖尿病患者作为观察组,又进一步分为正常尿清蛋白组[尿清蛋白/肌酐比值(UACR)<30 mg/g)、微量尿清蛋白组(30 mg/g≤UACR<300 mg/g)和大量尿清蛋白组(UACR≥300 mg/g)。选取健康成年人78例作为对照组。采用酶联免疫吸附试验检测两组血清sKlotho、NGAL、IL-6和IL-18的水平,并分析其与尿清蛋白、血尿肌酐、估算肾小球滤过率(eGFR)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、口服糖耐量试验2 h血糖(2 h PG)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)以及甘油三脂(TG)的相关性。结果观察组收缩压和舒张压明显高于对照组(P<0.05);eGFR、HbA1c、FPG、2 h PG、HOMA-IR、TC、TG、sKlotho、NGAL、IL-6和IL-18在不同肾脏损伤程度分组中差异有统计学意义(P<0.05);sKlotho与UACR、HbA1c、FPG、2 h PG、HOMA-IR、TC和TG均呈负相关(P<0.05),与eGFR呈正相关(P<0.05);NGAL、IL-6、IL-18水平分别与体质量指数、UACR、HbA1c、FPG、2 h PG、HOMA-IR、TC和TG呈正相关(P<0.05),分别与eGFR呈负相关(P<0.05)。结论2型糖尿病患者血清中sKlotho、NGAL、IL-6和IL-18异常表达,且与肾脏损伤程度相关。sKlotho、NGAL、IL-6和IL-18可能作为早期诊断标志物,可能与炎症反应和肾脏损伤程度有关。

Objective To investigate the expression and significance of secreted Klotho(sKlotho),Neutrophil gelatinase-associated lipocalin(NGAL),interleukin(IL)-6 and IL-18 in type 2 diabetic patients.Methods A total of 178 patients with type 2 diabetes in the hospital were divided into normal urine albumin group(UACR<30 mg/g),microalbuminuria group(30 mg/g≤UACR<300 mg/g)and a large number of urinary albumin group(UACR>300 mg/g)based on the urinary albumin/creatinine ratio(UACR).In addition,78 healthy people were enrolled as the healthy control group in the same period.Collected urinary albumin,hematuria creatinine,estimated glomerular filtration rate(eGFR),glycosylated hemoglobin(HbA1c),fasting plsma glucose(FPG),oral glucose tolerance test blood glucose 2 h(2 h PG)and insulin resistance index(HOMA-IR),total cholesterol(TC)and glycerin three greases(TG)index of the subjects;Enzyme linked immunosorbent assay(ELISA)was used to detect serum levels of sKlotho,NGAL,IL-6 and IL-18.Results The systolic blood pressure in type 2 diabetic patients was significantly higher than that in the healthy control group(P<0.05).Blood pressure was significant different in different degrees of renal injury in the observation group(P<0.05).EGFR,HbA1c,FPG,2 h PG,HOMA-IR,TC,TG,sKlotho,NGAL,IL-6 and IL-18 was significant different in different degrees of renal injury in the observation group(P<0.05).Serum sKlotho levels were negatively correlated with UACR,HbA1c,FPG,2 h PG,HOMA-IR,TC and TG(P<0.05),and positively correlated with eGFR(P<0.05)in patients with type 2 diabetes;serum levels of NGAL,IL-6 and IL-18 were positively correlated with body mass index,UACR,HbA1c,FPG,2 h PG,HOMA-IR,TC,and TG(P<0.05),and negatively correlated with eGFR(P<0.05).Conclusion Serum levels of sKlotho,NGAL,IL-6 and IL-18 may be the markers for early diagnosis of type 2 diabetes,and the mechanism may be related to inflammation and kidney damage.