2型糖尿病合并糖尿病肾病脂联素水平变化及与血管内皮功能的关系

目的探讨糖尿病肾病患者血清脂联素水平的变化,及与血管内皮功能的关系。方法 50例无明显临床大血管并发症的2型糖尿病患者,按24 h尿白蛋白排出量分为正常白蛋白尿组、微量白蛋白尿组及大量白蛋白尿组。检测血清脂联素、可溶性血管细胞黏附分子1、生物化学指标、肱动脉内皮依赖性舒张功能(FMD)、含服硝酸甘油后肱动脉内皮依赖性舒张功能(NID)、心脏结构参数及颈动脉内膜-中膜厚度。结果大量白蛋白尿组脂联素水平是正常白蛋白尿组的4倍,是微量白蛋白尿组的2倍(P<0.01和P<0.05)。微量白蛋白尿组脂联素水平比正常白蛋白尿组升高(P<0.05)。脂联素/血肌酐在三组中有同样的变化(均P<0.05)。大量白蛋白尿组和微量白蛋白尿组可溶性血管细胞黏附分子1均高于正常白蛋白尿组(P<0.01和P<0.05)。大量白蛋白尿组FMD、NID随脂联素水平的增加而下降(P<0.05)。颈动脉内膜-中膜厚度在三组间无统计学差异。脂联素与可溶性血管细胞黏附分子1、24 h尿白蛋白排出量、血肌酐、左心室后壁厚度、内膜-中膜厚度呈正相关(r值分别为0.338、0.704、0.470、0.331、0.324,P<0.05),与FMD、NID呈显著负相关(r值为-0.397、-0.413,P<0.01)。结论糖尿病肾病伴随高脂联素血症,且与血管内皮功能损害密切相关。脂联素可作为糖尿病肾病患者早期血管内皮功能障碍的预测指标。

Alteration of Plasma Adiponectin and Its Relationship to Vascular Endothelial Function in Type 2 Diabetic Patients with Diabetic Nephropathy

Aim To investigate the level of plasma adiponectin in patients with diabetic nephropathy,and its relationship to vascular endothelial function.Methods Fifty type 2 diabetic patients without clinical macrovascular complications were randomly assigned to normal albuminuria group(NAU),microalbuminuria group(MAU) and macroalbuminuria group(CAU) according to the daily urinary albumin excretion(UAE).Plasma adiponectin,soluble vascular cell adhesion molecule-1(sVCAM-1) and other biochemical indexes were measured.Color Doppler examination was followed to evaluate flow-mediated vasodilation(FMD),nitroglycerin vasodilation(NID),cardiologic parameters and intima-media thickness(IMT).Results In CAU group,plasma concentration of adiponectin was 4-fold and 2-fold higher than that in NAU group and MAU group respectively(13.3±5.0 mg/L vs 3.7±1.6 mg/L vs 5.7±2.2 mg/L,P<0.01 and P<0.05),while the difference between NAU group and MAU group was also significant(P<0.05).The ratio of adiponectin to serum creatinine followed the same trend along three groups(P<0.05).Plasma sVCAM-1 was significantly increased in MAU group and CAU group than that in NAU group(P<0.01 and P<0.05).FMD and NID were signifi-cantly decreased in contrast to the increment of plasma adiponectin(P<0.05).IMT was comparable between three groups(P>0.05).Finally,adiponectin was positively correlated with sVCAM-1,UAE,creatinine,left ventricular posterior wall thickness and IMT(r=0.338,0.704,0.470,0.331,0.324 respectively,all P<0.05),while negatively correlated with FMD and NID(r=-0.397 and-0.413 respectively,P<0.01).Conclusions Diabetic nephropathy is accompanied with hyperadiponectinemia,which is closely related to vascular endothelial dysfunction.Adiponectin may act as an early predictor of vascular endothelial dysfunction in these patients.