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目的观察1型糖尿病患儿血管内皮损害标志物—内皮素(ET)和血管性假血友病因子(von Wille-brand因子,vWF)的变化,分析其与尿白蛋白排泄率(UAER)的关系,从而筛查出更敏感的早期诊断糖尿病肾病(DN)的指标。方法收集1998-06—2005-06在山东省立医院就诊的4~18岁1型糖尿病患儿40例,根据UAER分为正常白蛋白尿组(A组)25例和微量白蛋白尿组(B组)15例,同时以年龄、性别、身高1∶1匹配的健康儿童作为对照组,分别检测其血糖(FBG)、糖化血红蛋白(HbA1c)、血浆ET和vWF的变化,并分析其相关性。结果与正常对照组比较,1型糖尿病患者血浆ET-1和vWF、HbA1c明显增高,尤其是微量白蛋白尿组升高更明显(均P<0·01),血浆ET-1和vWF与UAER、HbA1c均呈正相关。结论1型糖尿病患儿在出现白蛋白尿前已存在血管内皮功能异常,其白蛋白排泄与血管内皮功能障碍程度有一定相关性。血浆ET-1、vWF检测可作为早期筛查糖尿病肾病的可靠指标。

Detection of the plasma endothelin and von Willebrand factor and its relationship with microalbuminuria in children with type 1 diabetes mellitus

??AbstractObjectiveTo measure the plasma markers of endothelia damages in type 1 diabetes mellitus with normoalbuminuria and with microalbuminuria,and study possible relationship between them??and to find out the reliable indexes of early diagnosis for diabetic nephropathy.MethodsThe study group included 40 children with type 1 diabetes mellitus aged from 4~18 years old.They were divided into two groups according to urinary albumin excretion rate(UAER) at the beginning of the study,UAER??20??g/min as group A(n=25),and 20??UAER?? 200??g/min as group B(n=15).Forty healthy children selected by paired investigation as a control group.Plasma endothelin(ET??1) and urinary microalbumin were assayed by radioimmunoassay technique??von Willebrand factor(vWF) was measured by ELISA technique.ResultsThe plasma levels of ET??1 and vWF elevated obviously in group A and group B compared with healthy control(P<0.01);all the changes mentioned above were more remarkable in group B than group A.Relative analysis demonstrated ET??1 and vWF were positively correlated with UAER and glycated Hb(HbA1c)??respectively.ConclusionThe generalized vascular endothelial damage precedes the development of microalbuminuria in type 1 diabetes mellitus.The plasma levels of ET??1 and vWF are well correlated with UAER??and may be the reliable indexes of early monitoring diabetic nephropathy in patients with type 1 diabetes mellitus.