脂源性细胞因子在糖尿病肾病中的作用

目的 探讨脂源性细胞因子脂联素（adiponectin,APN）和瘦素（Leptin）在2型糖尿病（T2DM）中的变化以及与尿白蛋白排泄率（UAER）的关系和瘦素抵抗在T2DM中的作用.方法 用RIA法测定T2DM患者血浆Leptin、用ELISA法测定血清APN、用全自动生化分析仪常规测定尿UAER以及用吡格列酮治疗后APN、Leptin和UAER的变化.用t检验和两因素的直线相关分析r统计.结果 DM、DN组Leptin水平均较正常人显著升高（P＜0.01）,并随病程进展而逐渐增高（DM、DN组比较P＜0.01）,并与尿白蛋白排泄率呈正相关（r=0.292,P＜0.05）;DM、DN组APN水平均较正常人显著降低（P＜0.01）,并随病程进展而相对增高（DM、DN组比较P＜0.01）,并与尿白蛋白排泄率呈正相关（r=0.284,P＜0.05）;DN组经吡格列酮治疗后,能相对降低尿白蛋白水平（P＜0.01）和血浆Leptin（P＜0.01）水平,能相对提高APN水平.结论 高Leptin血症、高UAER和低APN血症与DM、DN的发生发展有关,吡格列酮具有一定的改善胰岛素抵抗和瘦素抵抗作用,对指导糖尿病的治疗有积极的意义.

Role of Adiponectin in Diabetic Nephropathy

Objective To explore the changes of adiponectin （APN） and leptin in patients with type 2 diabetes mellitus （T2DM）,the relationship with urinary albumin excretion rate （UAER） and the role in leptin resistance.Methods The levels of plasma leptin,APN and UAER in high-risk T2DM patients before and after pioglitazone treatment were determined by RIA,ELISA and automatic biochemistry analyzer respectively.Results The leptin levels in DM and DN group were higher than that of normal group （P 〈 0.01）,and it gradually increased as the disease progresses.The leptin levels was positively related with urinary albumin excretion rate （r =0.292,P 〈 0.05）.The APN levels in DM and DN group were lower than that of normal group （P 〈 0.01）,and it gradually increased as the disease progresses.The APN levels was positively related with urinary albumin excretion rate （r =0.284,P 〈 0.05）.The levels of urinary albumin and plasma leptin in DN group patients after pioglitazone treatment were decreased,while the APN levels were relatively increased.Conclusion The higher leptin and UAER with lower APN are related with the occurrence and development of DM and DN.The pioglitazone has certain role in improvement of insulin and leptin resistance and may have positive significance for guiding the treatment of patients with diabetes.