糖尿病患者血清基质金属蛋白酶-9、尿白蛋白排泄率与血管内皮功能的关系

目的 观察糖尿病患者不同程度尿白蛋白排泄率、基质金属蛋白酶-9（MMP-9）对血管内皮功能的影响.方法 将90例糖尿病患者按照24小时尿白蛋白排泄率分为正常蛋白尿组、微量白蛋白尿组和大量白蛋白尿组,记录其病程,通过调查问卷调查近3天的饮食情况并输入“开同食谱计算器”,估算其每日蛋白摄入量的平均值.空腹采血测定血糖、糖化血红蛋白、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和MMP-9浓度,通过超声测定其肱动脉血管内径、基础血流、内皮依赖性血管舒张功能及硝酸甘油介导的血管舒张功能,通过99mTc-二已三胺乙酸ECT法测定肾小球滤过率,并与30名同期体检的健康人群进行比较.结果 随尿白蛋白排泄率升高,3组糖尿病患者糖化血红蛋白、三酰甘油、MMP-9浓度升高（P＜0.05）,而高密度脂蛋白胆固醇、肾小球滤过率下降（P＜0.05）,内皮功能逐渐减退,与对照组比较,微量和大量白蛋白尿组内皮依赖性血管内径变化率明显降低（P＜0.05）.所有患者饮食中日均蛋白质摄入量均超过1 g/kg.结论 随糖尿病患者尿白蛋白排泄率增加,进行性出现MMP-9升高,血管内皮功能紊乱,而糖尿病患者未能严格落实饮食中蛋白质摄入的管理.

Relationship of urinary albumin excretion rate and MMP-9 on vascular endothelial function in diabetic patients

Objective To observe the effect of different urinary albumin excretion rate （UAER） and matrix metalloproteinase-9 （MMP-9） on vascular endothelial function in diabetic patients. Method According to 24-hour UAER,90 diabetic patients were divided into diabetic control group, microalbumin- uria group and macroalbuminuria group. Course of disease was recorded. 3-day diet was investigated by questionnaire and input into KaiTong Diet Calculator. Average daily protein intake was esstimated. Fasting Blood glucose, glycosylated hemoglobin, LDL-cholesterol, HDL-cholesterol and MMP-9 were measured. Di- ameter,basal blood flow, endothelium-dependent vasodilation, and nitroglycerin-mediated vasodilation of brachial artery were determined by ultra-sound. Glomerular filtration rate was determined by 99mTc-diethyl- enetriamine acetic acid ETC asssay. All the results were compared with those of 30 healthy individuals un- dergoing physical examination. Result Along with the increase of UAER, glycosylated hemoglobin, tri- glyceride and MMP-9 were increased. HDL-cholesterol, GFR were decreased, endothelium-dependent di- ameter change rate of brachial artery were contrary with 24-hour UAER. Endothelium function was de- creased by degrees. Compared with the control, endothelium-dependent diameter change rate of hrachial artery were remarkably decreased in microalbuminuria group and maeroalbuminuria group. Diet protein in- take in all the patients was lg/kg above one day. Conclusion Along with the increase of UAER and MMP-9,vascular endothelial function disorder progressively appeared. Diet protein intake management was not conducted indiabetie patients.