血清淀粉样蛋白A与2型糖尿病肾病患者颈动脉内膜中层厚度的相关性研究

目的 探讨血清淀粉样蛋白A （SAA）在2型糖尿病肾病（DN）的改变及与颈动脉内膜中层厚度（CIMT）的相关性.方法 根据24h尿微量白蛋白排泄率（UAER）将75例2型糖尿病患者分为2组：单纯糖尿病组（SDM组,39例）和早期糖尿病肾病组（EDA组,36例）,同时以35例健康人作为正常对照组（NC组）.用ELISA法检测各组空腹血清SAA浓度,同时测定各组的肌酐（Cr）、尿素氮（BUN）、血糖血脂、胰岛素抵抗指数（HOMA-IR）、超敏C反应蛋白（Hs-CRP）、CIMT等指标,并分析血清SAA与CIMT及其他指标的相关性.结果 EDA组和SDM组SAA水平明显高于NC组分别为（7.98±0.63 vs.6.09 ±0.72vs.2.75 ±0.30 mg/L）,P＜0.05或P＜0.01];EDA组、SDM组和NC组CIMT值组间比较均有统计学差异分别为（1.07±0.13vs.0.86 ±0.22 vs.0.72±0.13mm）,P＜0.05或P＜0.01].SAA水平与Hs-CRP、IL-6、FBG、HOMA-IR、CIMT、颈动脉斑块数量和UAER成明显正相关,与HDL-C成明显负相关（P＜0.05或P ＜0.01）.EDN组双侧斑块数量≥2个的患者SAA水平显著高于斑块只有1个或无斑块的患者（P＜0.01）,与斑块厚度呈正相关（r=0.409,P ＜0.05）.UAER、HOMA-IR、CIMT和Hs-CRP是影响DN患者SAA水平的独立影响因素.结论 联合检测SAA和CIMT可推断SAA对动脉粥样硬化的影响,全面的评价早期糖尿病肾损害,提示临床应早期干预血浆SAA水平防治DN及其他微血管和大血管病变.

Association of serum amyloid A with carotid intima-media thickness in type 2 diabetes patients accompanied with diabetic nephropathy

Objectives To investigate change of serum amyloid A （SAA） levels in type 2 diabetic patients （T2DM） accompanied with diabetic nephropathy （DN） and association of SAA with carotid intima-media thickness （CIMT）.Methods 75 patients with newly diagnosed T2DM were divided into simple T2DM group （SDM group,39 cases）,and early diabetic nephropathy group （EDN group,36 cases）,and meanwhile choose 35 patients of health examination as control group（NC group）.SAA levels were assayed by ELISA technique,and related parameters such as creatinine （Cr）,blood urea nitrogen（BUN）,blood glucose and lipids,HOMA-insulin resistance index （HOMA-IR）,high-sensitivity C-reactive protein （hsC-RP）,CIMT were measured.The relationship between SAA levels,CIMT,other metabolic parameters was also analyzed.Results SAA levels in patients with SDM and EDA groups were significantly increased compared with that of NC group （7.98 ±0.63 vs.6.09 ±0.72 vs.2.75 ± 0.30 mg/L,respectively,P ＜ 0.05 orP ＜ 0.01）.CIMT value in patients with SDM and EDA groups was significantly increased compared with that of NC group （1.07 ±0.13vs.0.86 ±0.22 vs.0.72 ±0.13mm,respectively,P ＜0.05 or P ＜0.01）.SAA level in DN group was positively related to Hs-CRP,interleukin-6 （IL-6）,FBG,HOMA-IR,CIMT,quantitative carotid plaque and urinary albumin excretion rate （UAER）,and negatively with high-density lipoprotein cholesterols （HDL-C） （P ＜0.05 orP ＜0.01）.SAA levels in patients with two or more plaques bilaterally were significantly increased compared with that of only one or less plaque in EDA group （P ＜ 0.01）.SAA levels in EDA group was positively related to thickness of plaque （r =0.409,P ＜ 0.05）.Multiple regression analysis showed that UAER,HOMA-IR,CIMT and Hs-CRP were the independent risk factors of SAA in DN patients.Conclusions Measurement of SAA combined with CIMT can infer effect of SAA on atherosclerosis,evaluate the lesion of early diabetic nephropathy overall,which suggested th