糖尿病肾病脂蛋白(a)质量浓度变化对尿白蛋白排泄率的影响

目的探讨血清脂蛋白(a)[Lp(a)]质量浓度变化与糖尿病肾病(DN)进展之间的关系以及降低血清Lp(a)质量浓度在防治DN进展中的意义。方法对广东省东莞市人民医院2002-04～2004-09门诊及住院270例糖尿病患者分为单纯糖尿病(SDM)组、早期糖尿病肾病(EDN)组和临床糖尿病肾病(CDN)组各90例,比较其与正常对照组的血清Lp(a)水平;两组DN患者在常规治疗基础上每晚服用氟伐他汀40mg。分析血清Lp(a)质量浓度变化与DN进展之间的关系。结果⑴SDM组血清Lp(a)质量浓度与正常对照组比较无显著性差异(P>0.05),EDN、CDN组血清Lp(a)质量浓度明显高于正常对照组和SDM组(P<0.01),CDN组血清Lp(a)质量浓度明显高于EDN组(P<0.01)。血清Lp(a)质量浓度与尿白蛋白排泄率(UAER)呈直线正相关(r=0.396,P<0.01)。⑵两组DN患者血清Lp(a)水平显著降低(P<0.01)。结论血清Lp(a)质量浓度升高与DN进展有关,降低血清Lp(a)质量浓度能有效减轻EDN患者的蛋白尿、改善肾功能,但对CDN患者无效。

The effects of lipoprotein(a) level in diabetic nephropathy on urinary albumin excretion rate

ObjectiveTo investigate the relationship between lipoprotein(a) levels and evolution of diabetic nephropathy (DN),and the significance of lowering the serum Lp(a) in prevention of the progression of DN.MethodsSerum Lp(a) concentration was measured and compared in non-diabetic controls and 3 groups of type 2 diabetes mellitus patients,including 90 without DN[urinary albumin excretion rate(UAER)<30mg/24h,group SDM],90 with microalbuminuria(UAER 30~300 mg/24 h,group EDN) and 90 with clinical albuminuria (UAER>300mg/24h,group CDN).Two groups with DN were given ordinary treatment and added with oral 40 microgram of fluvastatin every night.All patients had been followed up for nine months. Lp(a),FBG,UARE and Scr were compared between two groups before treatment and nine months after treatment.ResultsLp(a) levels were similar between group SDN and non-diabetic controls(P>0.05).But in the group EDN and CDN,Lp(a) was significantly higher as compared with the former two groups (P<0.01).There was a positive correlation between Lp(a) concentration and UAER(r=0.396,P<0.01).The levels of Lp(a) in treated group EDN and group CDN had been decreased significantly(P<0.01).ConclusionIncrease of serum Lp(a) may be related to the evolution of DN.Lowering the serum Lp(a) can ameliorate microalbuminuria and improve renal function in patients with EDN,but not for those with CDN.