高敏C-反应蛋白与2型糖尿病肾病

目的： 前瞻性探讨2型糖尿病（DM）患者高敏C-反应蛋白（hs-CRP）与糖尿病肾病（DN）及其发生风险的关系。 方法：应用ELISA法测定55例正常对照组、66例不伴DN和68例伴DN的2型糖尿病患者的hs-CRP水平，比较3组间的差异；对58例入组时无DN的2型糖尿病患者进行降糖、降压等措施综合干预，追踪观察5年，观察干预前后尿白蛋白排泄率（UAE）、hs-CRP及肾功能的动态变化。 结果：入组时，2型糖尿病组的血清hs-CRP水平高于正常对照组（P＜0.05)；在年龄，BMI，糖尿病病程，平均动脉压，空腹血糖，糖化血红蛋白及血肌酐都匹配的条件下，入组时DN组的hs-CRP水平高于无DN的DM 组和正常对照组（P<0.05）；28例在随访终点发生DN的DM患者与30例在随访终点未发生DN患者比较，前者入组时和随访结束时的血清hs-CRP水平高于后者（P＜0.05)；经降糖、降压等综合治疗5年后，终点时未发生DN的DM1组血清hs-CRP水平低于入组时（P＜0.05)，而发生了DN的DM2组终点的血清hs-CRP水平虽较入组时略低，但差异无统计学意义（P＞0.05）。 结论：高敏C-反应蛋白水平在DM组和DN组逐渐增高,表明其可能是2型DM和DN发生的危险因素；终点发生DN的DM患者有高水平的hs-CRP基线值，在一定程度上能够预测2型糖尿病患者发生DN的风险。

High-sensitive C-reactive protein and Type 2 diabetic nephropathy

OBJECTIVE: To prospectively investigate the relationship between high-sensitive C-reactive protein (hs-CRP) and Type 2 diabetic nephropathy. METHODS: We assayed serum hs-CRP concentration in 55 normal controls, 66 Type 2 diabetic patients without diabetic nephropathy (DN) and 68 Type 2 diabetic patients with DN by ELISA. A 5-year prospective study was designed to investigate the changes of urinary albumin excretion (UAE), serum hs-CRP concentration, and kidney funciton in targeted intervention including blood glucose and blood pressure in 58 diabetic patients without DN at the baseline. RESULTS: Baseline hs-CRP concentration was the highest in Type 2 diabetic patients with DN, followed by Type 2 diabetic patients without DN, and the lowest in normal controls. After 5-year intervention, hs-CRP concentration at the endline was significantly lower than that at the baseline in the patients in whom DN didn't occur at the endline (P < 0.05). But in the patients in whom DN occured at the endline, hs-CRP concentration was slightly lower than that at the baseline (P > 0.05). Both baseline and endline, the hs-CRP concentrations in the patients in whom DN occured at the endline were significantly higher than those without DN at the endline. CONCLUSION: Higher serum hs-CRP concentration in patients with Type 2 diabetes may be a risk factor that gives rise to DN. To some extent hs-CRP can predict the occurrence of DN in Type 2 diabetic patients.