糖尿病患者微炎症及免疫状况与肾脏病变的关系

目的对糖尿病患者早期肾损害进行评估,探讨2型糖尿病(T2DM)患者微炎症状态以及体液免疫、细胞免疫功能与肾脏病变的关系。方法将116例早期2型糖尿病肾病(DN)患者根据24 h尿微量白蛋白排泄率(UAER)分为:无蛋白尿组(n=36)、微量蛋白尿组(n=39)和大量蛋白尿组(n=41)。观察患者血清血肌酐(Scr)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、半胱氨酸蛋白酶抑制物C(CY-SC)、糖化血红蛋白(HbA1c)、尿白蛋白排泄率(UAER)和超敏C-反应蛋白(hs-CRP)水平以及机体免疫反应(CD3、CD4、CD8、CD4/CD8、B细胞、NK细胞、IgG、IgA、IgM、C3、C4)水平的改变,并与正常对照组(n=56)进行对比。结果无蛋白尿组、微量蛋白尿组及大量蛋白尿组的hsCRP和机体免疫反应水平水平均明显高于正常对照组(P<0.01);微量蛋白尿组的hs-CRP、CYSC水平明显高于无蛋白尿组(P<0.01);大量蛋白尿组的hs-CRP、CYSC水平明显高于微量蛋白尿组(P<0.01)。CD3、CD4、CD4/CD8、B细胞、NK细胞及IgG明显下降(P<0.05P<0.01),而IgA、IgM、C3、C4明显高于对照组(P<0.01)。结论对于糖尿病患者早期检测血清hs-CRP、HbA1c、eGFR、TC、TG、LDL-C、Cystatin C和UAER水平的变化可以作为临床观察DN病情及判断DN预后的参考指标;早期DN患者存在微炎症和免疫功能下降,消除或控制促炎因素,改善早期DN患者细胞免疫及体液免疫功能障碍,从而延缓慢性肾脏病的发生、发展。     

2型糖尿病患者血清护骨素水平与糖尿病肾病的关系

目的 2型糖尿病(T2DM)患者血清护骨素水平与糖尿病肾病(DN)的关系.方法 110例T2DM患者根据尿白蛋白排泄率(UAER)分为正常白蛋白尿组 38例、微量白蛋白尿组 36例及大量白蛋白尿组 36例,同时选择年龄、性别相匹配的40例健康者为对照组.血清护骨素采用ELISA法测定.结果 在T2DM各组中,大量白蛋白尿组患者的血清护骨素水平[(4.45±0.76)ng/L]显著高于微量白蛋白尿组[(3.62±0.70)ng/L]、正常白蛋白尿组[(2.77±0.78)mg/L]和对照组[(2.29±0.37)ng/L](均P＜0.01);微量白蛋白尿组患者的血清护骨素水平高于正常白蛋白尿组.血清护骨素水平与空腹血糖(FPG)、糖化血红蛋白(HbA1c)、超敏C反应蛋白(hs-CRP)及UAER呈明显正相关.血清护骨素水平是DN的重要影响因素.结论 DN患者血清护骨素水平明显升高,护骨素可能在DN的发生中起一定作用.     

老年2型糖尿病患者血清超敏C反应蛋白与糖尿病肾病相关性分析

目的 分析老年2型糖尿病(T2DM)患者血清超敏C反应蛋白(hsCRP)与糖尿病肾病(DN)的相关性及临床意义.方法 72例老年T2DM患者根据尿白蛋白排泄率(UAER)分为:正常白蛋白尿组(A组)30例,微量白蛋白尿组(B组)22例,临床白蛋白尿组(C组)20例;另设健康对照组(D组)30例.采用免疫透射比浊法测定各组血清hsCRP浓度,比较T2DM各组与对照组的hsCRP水平.结果 T2DM各组血清hsCRP水平较对照组明显升高,且随UAER的增高而升高.结论 hsCRP为DN的发病危险因素之一,且随DN病程的进展,hsCRP水平逐渐升高.     

糖尿病肾病患者血清抵抗素水平与24h尿白蛋白定量的关系

目的探讨糖尿病肾病（DN）患者血清抵抗素水平与24 h尿白蛋白定量的关系。方法选择2型糖尿病患者89例,根据尿白蛋白排泄率分为正常白蛋白尿组35例、微量白蛋白尿组32例和大量白蛋白尿组22例。分别观察各组患者的空腹血糖（FPG）、糖化血红蛋白、24 h尿白蛋白定量、高敏C反应蛋白（hs-CRP）和血清抵抗素水平。结果正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组的24 h尿白蛋白定量、hs-CRP和抵抗素水平依次升高（P〈0.05或〈0.01）。相关分析显示,DN患者的抵抗素水平与24 h尿白蛋白定量呈明显正相关（r=0.342,P〈0.05）。结论抵抗素可能在DN的发病中起着重要的作用,可作为DN严重程度的评判指标。     

早期糖尿病肾病血清 NGAL与致动脉硬化指数的关系

目的观察在早期糖尿病肾病(DN)患者血清中性粒细胞明胶酶相关载脂蛋白(NGAL)水平的变化,探讨NGAL与致动脉硬化指数(AIP)的关系。方法选取尿微量白蛋白/肌酐300 mg/g的糖尿病患者120例为糖尿病组,根据尿微量白蛋白/肌酐分为正常白蛋白尿组和早期DN组,另选取健康体检者60例作为对照组。检测各组血清甘油三酯(TG)、胆固醇(CHOL)、高密度脂蛋白(HDL)、NGAL、超敏C反应蛋白(hs-CRP)等,并计算致动脉硬化指数;分析3组NGAL、hs-CRP、AIP的变化。按照AIP三分位数将所有研究对象分成低、中、高水平3组,分析其NGAL和hs-CRP的变化。对所有变量进行简单线性相关和多元线性逐步回归分析。结果与对照组比较,正常白蛋白尿组和早期DN组NGAL、hs-CRP、AIP水平明显升高(P0.001);与正常白蛋白尿组比较,早期DN组NGAL、hs-CRP、AIP水平明显升高(P0.001)。血清NGAL水平随AIP上升而明显上升(P0.001)。AIP与hsCRP、NGAL呈正相关(r=0.296,0.313,P0.05);NGAL、hs-CRP为AIP的独立影响因素。结论血清NGAL是监测糖尿病早期肾损伤的指标。NGAL是一个急性时相反应蛋白,参与了糖尿病肾病动脉粥样硬化的发生发展。     

老年2型糖尿病肾病患者血清C肽与尿白蛋白排泄率的关系

目的研究老年2型糖尿病肾病患者血清C肽水平与尿白蛋白排泄率的关系。方法选取老年2型糖尿病患者44例,分别测定血清C肽水平、糖化血红蛋白(HbA1c)、空腹血糖及尿白蛋白排泄率,并据尿白蛋白排泄率分为正常白蛋白尿组、微量白蛋白尿组、临床白蛋白尿组。结果临床白蛋白尿组血清C肽水平低于其他两组,差异有显著性意义(P<005)。血清C肽水平与尿白蛋白排泄率呈负相关(r=-0629,P<001)。结论血清C肽水平的下降可能参与老年2型糖尿病肾病的发生发展。     

糖尿病肾病患者血清电解质水平变化的研究

目的 探讨糖尿病肾病(DN)患者血清电解质变化,及与尿微量白蛋白的相关性.方法 选取2013年4月至2014年10月在天津中医药大学第二附属医院内科住院的2型糖尿病患者450例,按尿微量白蛋白排泄率(UAER)结果分为3组,＜20 μg/min为无DN组(176例),20～200 μg/min为微量白蛋白尿组(182例),≥200 μg/min为大量白蛋白尿组(92例).同时检测患者血清电解质钾、钠、氯、磷、镁、钙水平,并留取患者一般资料,分析各种电解质变化与DN的关系.结果 3组间的钾、磷、钙、镁水平有差异,大量白蛋白尿组的钾(F=11.139,P＜0.01)、磷(F=3.115,P＜0.05)水平最高,镁(F=7.251,P＜0.05)、钙(F=5.721,P＜0.01)水平最低.微量白蛋白尿组与大量白蛋白尿组患者的钾、磷水平均高于无DN组,镁水平低于无DN组(P＜0.05或P＜0.01).大量白蛋白尿组钙水平低于无DN组(P＜0.01).与微量白蛋白尿组相比,大量白蛋白尿组钾、磷水平升高,而钙、镁水平降低(P＜0.05或P＜0.01).直线相关分析显示,磷、钾水平与24 h尿微量白蛋白呈正相关(r=0.348,0.258,P＜ 0.001).钙、镁水平与24h尿微量白蛋白呈负相关(r=-0.360,-0.374,P＜0.001).结论 DN患者随着尿微量白蛋白的增多,钾、磷水平逐渐升高,镁、钙水平逐渐降低.     

糖尿病肾病患者血清MMP-9、hs-CRP、TNF-α变化及意义

目的 探讨2型糖尿病肾病（DN）患者血清基质金属蛋白酶-9（MMP-9）、高敏C-反应蛋白（hs-CRP）、TNF-α变化及其临床意义.方法 选择2型糖尿病（T2DM）患者90例,根据尿白蛋白排泄率（UAER）分为单纯糖尿病（DM）组28例、早期糖尿病肾病（DN1）组33例、临床糖尿病肾病（DN2）组29例;另选体检健康者30例作为对照组.采用ELISA法检测各组血清MMP-9、hs-CRP、TNF-α.结果 DM组、DN1组、DN2组血清MMP-9、hs-CRP、TNF-α均高于对照组（P均＜0.05）;DM组、DN1组、DN2组血清MMP-9、hs-CRP、TNF-α逐渐升高,组间比较均有统计学差异 （P均＜0.05）.结论 MMP-9、hs-CRP、TNF-α是DN病程中的重要炎症介质,三者在DN发生、发展中可能起重要作用.     

老年2型糖尿病患者尿蛋白排泄率与高敏C反应蛋白、血尿酸水平关系分析

目的探讨老年2型糖尿病(T2DM)患者尿蛋白排泄率(UAER)与高敏C反应蛋白(hs-CRP)、血尿酸(UA)水平的关系。方法根据UAER将94例老年T2DM患者分为3组,正常蛋白尿组(A组)、微量蛋白尿组(B组)和大量蛋白尿组(C组)。分别测定3组的hs-CRP、UA水平以及血压、血糖、血脂等相关临床生化指标,并进行比较。结果B组和C组hs-CRP、UA明显高于A组,B组和C组间也有统计学差异(P<0.05或P<0.01)。3组间在年龄、病程、血压、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)和高密度脂蛋白胆固醇(HDL-C)方面也存在显著性差异(P<0.05或P<0.01)。相关性分析显示,UAER与hs-CRP、UA均呈正相关(分别为r=0.331,P<0.01;r=0.254,P<0.05)。结论 hs-CRP和UA与老年糖尿病肾病(DN)的发生明显相关,在老年DN的预测中有一定临床意义。     

非肥胖2型糖尿病患者血清内脂素与不同阶段糖尿病肾病的关联性研究

目的研究非肥胖2型糖尿病患者血清内脂素(visfatin)与尿微量白蛋白/肌酐(ACR)之间的相关性,探讨内脂素在不同阶段糖尿病肾病中的改变。方法收集体重指数(BMI)28 kg/m2的2型糖尿病患者90例,按照尿ACR分为单纯糖尿病组30例(T2DM组,尿ACR30μg/mg),微量蛋白尿组30例(DN1组,尿ACR30~300μg/mg),大量蛋白尿组30例(DN2组,尿ACR300μg/mg),健康体检人员组(对照组)30例,测定血清内脂素及血脂、血糖等生化指标。结果非肥胖2型糖尿病患者组血清内脂素水平显著高于对照组(P0.01),糖尿病肾病患者组血清内脂素水平显著高于单纯糖尿病组(P0.01),其中大量蛋白尿组血清内脂素水平显著高于微量蛋白尿组(P0.01)。血清内脂素与尿ACR水平呈正相关(r=0.558,P0.01)。结论非肥胖的2型糖尿病患者血清内脂素水平升高,与尿ACR密切相关,随着糖尿病肾病加重,内脂素也逐渐升高。内脂素有希望作为糖尿病肾病的治疗靶点。     

2型糖尿病患者血超敏C反应蛋白和微血管并发症的关系

目的分析2型糖尿病患者各种微血管并发症和血超敏C反应蛋白(hsCRP)的关系。方法以2003年5月至2006年6月北京协和医院内分泌科321例2型糖尿病住院患者为研究对象。根据尿白蛋白排泄率(UAER)分为无肾病组(UAER<20μg/min)213例,早期肾病组(20μg/min≤UAER<200μg/min)62例和临床肾病组(UAER≥200μg/min)46例;根据眼底镜检查分为无糖尿病视网膜病变组238例、有糖尿病视网膜病变组83例;根据肌电图检查分为无糖尿病神经病变组255例和有糖尿病神经病变组66例。观察3种并发症中各组hsCRP的变化。结果只有糖尿病肾病和血hsCRP相关,hsCRP随尿白蛋白的增加而升高。Pearson相关分析显示,hsCRP与UAER(r=0.448,P=0.002)、三酰甘油(r=0.385,P=0.008)及体重指数(r=0.261,P=0.004)呈正相关。逐步线性回归表明,UAER、三酰甘油、体重指数是影响hsCRP的主要因素。结论hsCRP与糖尿病肾病相关,其水平与糖尿病肾病的程度具有一致性。     

P-选择素与糖尿病肾病的相关性

目的观察不同阶段糖尿病肾病患者血清中P-选择素的水平变化,探讨其与糖尿病肾病的相关性。方法健康对照组为50名健康体检者,2型糖尿病患者150例分为正常蛋白尿组、微量白蛋白尿组及临床蛋白尿组,每组各50例。用酶联免疫吸附法检测血清P-选择素。结果所有糖尿病患者血清中P-选择素含量（17．36±6．19）ng／ml,均明显高于正常对照组[（7．25±1．69）ng／ml]（P〈0．01）;微量白蛋白尿组[（16．59±3．36）ng／ml]及临床白蛋白尿组[（23．84±5．96）ng／ml]P-选择素又高于正常白蛋白尿组[（12．34±2．31）ng／ml]（P〈0．01）;临床白蛋白尿组又高于微量白蛋白尿组（P〈0．01）;P选择素水平与空腹血糖、糖化血红蛋白、高敏C反应蛋白、尿白蛋白均呈正相关（r=0．54,0．68,0．97,0．71,P均〈0．01）。结论糖尿病肾病患者血清P-选择素的水平升高,可作为糖尿病肾病的检测指标之一。     

晨尿微量白蛋白浓度检测对筛检早期糖尿病肾病的临床价值

目的探讨晨尿微量白蛋白浓度检测对筛选早期糖尿病肾病的临床价值.方法110例2型糖尿病病人纳入研究,收集晨尿及24 h尿样,检测晨尿微量白蛋白浓度和24 h尿白蛋白排泄率(UAER),并绘制晨尿白蛋白浓度受试者工作曲线(ROC).结果晨尿微量白蛋白浓度与UAER相关(r=0.93,P＜0.001).晨尿微量白蛋白浓度的ROC 100%敏感度截断点微量白蛋白浓度值为10 mg/L(特异度为69%),敏感度与特异度最佳截断点微量白蛋白浓度值为25mg/L(敏感度90%,特异度88%).结论晨尿微量白蛋白浓度检测对于筛选早期糖尿病肾病准确性较高.且较UAER简便、经济,可作为筛检2型糖尿病早期肾病的方法之一.     

Increased urinary levels of CXCL5, CXCL8 and CXCL9 in patients with Type 2 diabetic nephropathy

CXC chemokines are particularly significant for leukocyte infiltration in inflammatory diseases. Recent reports have shown that inflammation is one of potential pathogenic mechanisms for diabetic nephropathy. However, information on inflammation related with CXC chemokines in human Type 2 diabetic nephropathy still remains scarce. We measured urinary and serum levels of three CXC chemokines, CXCL5, CXCL8 and CXCL9, in 45 Type 2 diabetic patients (DM), 42 primary renal disease (PRD) patients and 22 healthy controls by enzyme-linked immunosorbent assay. Urinary levels of CXCL5, CXCL8 and CXCL9 in DM were significantly elevated compared to those in controls (P<.0001, P<.01, P<.001; respectively). They increased consistent with urinary albumin excretion rate (UAER) and correlated with UAER in partial correlation analyses (r=0.41, P<.01; r=0.40, P<.01; r=0.45, P<.01; respectively). Urinary levels of CXCL5 in DM were significantly interrelated to HbA(1c) (r=0.42, P<.01). On the other hand, PRD showed significant increased levels of urinary CXCL8 and CXCL9 compared to controls (P<.001, P<.01; respectively), and so did PRD as UAER increased. However, there were no significant elevations of urinary levels of CXCL5 in PRD in spite of the increased UAER. We found significant associations of UAER in DM with diabetes duration, 1/serum creatinine, urinary CXCL5 (adjusted R(2)=0.67, P<.0001) or CXCL9 (adjusted R(2)=0.69, P<.0001) in a stepwise multiple regression analysis. These results suggest that these three CXC chemokines may be involved in the progression of human Type 2 diabetic nephropathy and that CXCL5 may be of use for telling diabetic nephropathy from primary renal diseases.     

Leptin, triglycerides, and interleukin 6 are independently associated with C-reactive protein in Japanese type 2 diabetic patients

The aim of the present study was to investigate the factors contributing to the concentration of serum C-reactive protein in type 2 diabetic patients. One hundred and 48 Japanese type 2 diabetic patients were studied. In conjunction with C-reactive protein (CRP), BMI, systolic and diastolic blood pressure, glycosylated hemoglobin (HbA1c), fasting concentrations of plasma glucose, and serum lipids (triglycerides, HDL cholesterol, and total cholesterol), interleukin 6 (IL-6), and leptin were measured. Insulin resistance was also estimated by the insulin resistance index of homeostasis model assessment (HOMA-IR). With univariate analysis, serum CRP was positively correlated with BMI (r=0.281, P<0.001), diastolic blood pressure (r=0.176, P=0.048), triglycerides (r=0.293, P<0.001), HOMA-IR (r=0.294, P<0.001), IL-6 (r=0.323, P<0.001), and leptin (r=0.330, P<0.001), and negatively correlated with HDL cholesterol (r=-0.181, P=0.028). Multiple regression analyses showed that serum CRP was independently predicted by the level of IL-6 (P<0.001, F=4.04), leptin (P<0.001, F=7.09), and triglycerides (P<0.001, F=15.13), which explained 17.6% of the variability of serum CRP concentration in these patients. From these results, it can be concluded that along with IL-6 and triglycerides, leptin is another important independent factor that is associated with CRP in Japanese type 2 diabetic patients.     

Plasma and urinary vascular endothelial growth factor and diabetic nephropathy in Type 2 diabetes mellitus.

AIMS: Vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of diabetes mellitus. We determined whether alterations of plasma and urinary VEGF levels are related to diabetic nephropathy in Type 2 diabetic patients. METHODS: One hundred and seven patients and 47 healthy controls were studied. Study subjects were divided into four groups using urinary albumin-to-creatinine ratio (ACR): a non-diabetic healthy control group (n = 47), a normoalbuminuric diabetic group (n = 37), a microalbuminuric diabetic group (n = 37) and an overt proteinuric diabetic group (n = 33). VEGF levels were measured by enzyme-linked immunosorbent assay. RESULTS: (i) Urinary VEGF concentrations were significantly higher in the diabetic groups, even at the normoalbuminuric stage (log VEGF/Cr, normoalbuminuria; 4.33 +/- 1.06 vs. control; 3.53 +/- 0.79, P = 0.009). Urinary VEGF excretions increased as diabetic nephropathy advanced. (ii) Plasma and urinary VEGF levels were higher in hypertensive diabetic patients than in the normotensive individuals with diabetes. (iii) In those with diabetes, plasma VEGF levels were found to be positively correlated with plasma urea (r = 0.398, P = 0.039) and urinary ACR (r = 0.251, P = 0.044), and urinary VEGF to be positively correlated with urinary ACR (r = 0.645, P < 0.001), and creatinine (r = 0.336, P = 0.009), and to be negatively correlated with serum albumin (r = -0.557, P < 0.001). Urinary VEGF and serum creatinine were independently correlated with urinary ACR. CONCLUSIONS: Urinary excretion of VEGF increased during the earlier stage of diabetic nephropathy and was significantly correlated with urinary albumin excretion. This suggests that urinary VEGF might be used as a sensitive marker of diabetic nephropathy and for predicting disease progression.     

Transforming growth factor-beta 1 in diabetic nephropathy

In diabetic nephropathy the extent of matrix accumulation in both glomeruli and the interstitium correlates strongly with the degree of renal insufficiency and proteinuria. Factors responsible for the deposition and accumulation of extra cellular matrix material within the kidney are therefore of considerable interest. Such factors include the potent fibrotic cytokine TGF-beta. We measured serum TGF-beta1 in patients with various stages of diabetic nephropathy, and correlated its level with different biochemical parameters. The study was conducted on: Group I: 30 patients with diabetic nephropathy (Subgroup IA: 20 patients with microalbuminuria; Subgroup IB: 10 patients with overt nephropathy), Group II: 19 diabetic patients without nephropathy (positive control), Group III: 20 healthy volunteers (negative control). Serum creatinine, Fasting and postprandial blood glucose, Fasting serum cholesterol, Glycated haemoglobin (HbA1c), Microalbumin estimation in urine, Serum TGF-beta1 estimation were done for all the studied groups. Our results showed a statistically significantly higher serum TGF-beta1 level in patients with diabetic nephropathy versus diabetic patients without nephropathy (mean +/- SD, 47.66 +/- 21.92 and 27.07 +/- 15.46 respectively) (P<0.001). Also in patients with diabetic nephropathy versus healthy controls (mean +/- SD, 47.66 +/- 21.29 and 27.05 +/- 8.95 respectively) (P<0.001). While serum TGF-beta1 concentrations were almost similar in diabetic patients without nephropathy and in healthy controls. Serum TGF-beta1 was statistically significantly higher in patients with overt nephropathy versus patients with microalbuminuria (mean+/-SD, 73.5 +/- 2.41 and 34.9 +/- 12.41) (P<0.001). Serum TGF-beta1 was significantly positively correlated with albumin excretion rate, fasting and postprandial blood glucose levels, serum cholesterol and HbA1c, these correlations were only found in diabetic patients with nephropathy but not in those without nephropathy or the control group. (r=0.86, P<0.001, r=0.444, P<0.05, r=0.375, P<0.05, r=0.532, P <0.01, r=0.696, P<0.001 respectively. HbA1c was found to be predictor of 68% of changes of serum TGF-beta1 (P<0.001) and serum cholesterol was predictor of 73% of changes of serum TGF-beta1 concentration (P<0.01). In conclusion, our results suggest that TGF-beta1 may play a key role in the development and progression of diabetic nephropathy. Accordingly, it may be also directly implicated in the functional deterioration of the kidney functions seen in patients with diabetic nephropathy, therefore beside proper glycemic control, strategies aiming at antagonizing TGF- beta1 for example by the use of specific antibodies or a specific inhibitor of TGF-beta1 may help to prevent the development or attenuate the progression of nephropathy in diabetic patients.     

住院2型糖尿病患者血清脂蛋白(a)水平及与糖尿病肾病的关系

目的 研究2型糖尿病患者血清脂蛋白(a)水平的变化,探讨其与糖尿病肾病的关系.方法 2007年1月至2008年11月我院内分泌代谢科收治的2型糖尿病患者1238例,年龄15～89岁,记录血压、体质量及病程,入院第2天测定卒腹及餐后2 h血糖、血脂谱、肾功能及尿白蛋白排泄率,应用肾脏病膳食改良试验公式计算肾小球滤过率.分别根据患者年龄、尿白蛋白排泄率及脂蛋白(a)水平进行分层.采用t检验、方差分析、多元逐步回归分析等进行统计学分析.结果 不同年龄组患者血清脂蛋白(a)水平差异无统计学意义(F=1.144,P>0.05).大量蛋白尿组血清脂蛋白(a)水平显著高于正常蛋白尿组和微量蛋白尿组(F=4.113,P<0.05).研究队列按照血清脂蛋白(a)的四分位点分为四组,随着血清脂蛋白(a)水平的升高,尿白蛋白排泄率逐渐升高(F=7.877,P<0.01),而肾小球滤过率逐渐降低(F=4.479,P<0.01).血清脂蛋白(a)与血清总胆固醇、低密度脂蛋白胆固醇、尿白蛋白排泄率呈正相关(r值分别为0.152、0.169、0.18,均P<0.01),与肾小球滤过率呈负相关(r=-0.061,P<0.01).多元逐步同归分析结果显示:影响尿白蛋白排泄率的主要因素包括收缩压、血清脂蛋白(a)水平、低密度脂蛋白胆固醇、肾小球滤过率、年龄.结论 2型糖尿病患者血清脂蛋白(a)水平不受年龄、病程及血糖控制情况的影响,是尿白蛋白排泄率的独立影响因素.     

Evaluation of serum adiponectin levels in diabetic nephropathy

IntroductionDiabetic nephropathy is one of the major microvascular complications of diabetes mellitus. Adiponectin is an adipose tissue-derived cytokine that was identified in a human adipose tissue cDNA library. Serum adiponectin levels are found to be reduced in various pathological states including obesity, diabetes mellitus, ischaemic heart disease and arteriosclerosis obliterans and elevated in end stage renal diseases. Objective: to assess the level of plasma adiponectin as an early predictor of microvascular complications in patients with type 2 diabetes mellitus.Methods44 patients with type 2 diabetes recruited from outpatient diabetes clinic in Kasr Alainy hospital. All patients were subjected to full laboratory work-up including: Fasting blood glucose and Post prandial blood glucose, Glycated haemoglobin A1C, Serum creatinine, Serum total cholesterol, Triglycerides, Low density lipoprotein, High density lipoprotein, C-reactive protein titre, serum adiponectin and Urinary albumin/creatinine (UAC) ratio.ResultsThe present study demonstrated that serum adiponectin concentrations had significant positive correlation with UAC ratio (r = 0.534, p = 0.0001). Adiponectin levels showed significant positive correlation in patients with diabetes and hypertension with microalbumiuria (p = .001) or normoalbumiuria (p = 0.004).ConclusionSerum adiponectin level can be a good predictor of diabetic nephropathy in patients with type 2 diabetes mellitus.     

2型糖尿病患者尿白蛋白排泄率与补体C5a的关系

目的探讨2型糖尿病患者血、尿补体活化片段C5a含量的变化与糖尿病肾病的关系。方法选2型糖尿病患者39例,健康体检者21名作为对照,检测血、尿C5a浓度以及血高敏C反应蛋白,测定尿白蛋白排泄率以及血糖控制情况,分析其关系。结果与对照组比较,2型糖尿病患者尿C5a浓度升高（11．4±21．1vs76．3±144．4,P〈0．05）,血C5a无明显变化,尿C5a与尿白蛋白排泄率正相关（r=0．378,P〈0．05）,糖尿病病程、尿C5a是尿白蛋白排泄率的独立预测因素。结论补体活化可能与糖尿病肾病的发生有关。