vWF和vWF裂解酶水平对糖尿病肾病的影响

目的 探讨糖尿病肾病（DN）患者血清血管性血友病因子（vWF）、vWF裂解酶（ADAMTS13）的水平及其作 用。方法 选取健康体检者（正常对照组）50例和2型糖尿病（T2DM）组合并DN患者144例，根据尿微量白蛋白与尿 肌酐比值（ACR），将患者分为单纯T2DM组（42例，ACR＜30 mg/g）、微量白蛋白尿组（56例，30 mg/g≤ACR?300 mg/g）， 大量白蛋白尿组（46例，ACR≥300 mg/g）。采用免疫透射比浊法检测vWF水平；双抗体夹心法检测ADAMTS13水平， 并检测血肌酐（sCr）、尿素氮（BUN）、糖化血红蛋白（HbA1c）、D-二聚体和纤维蛋白原（Fib）等，计算估计的肾小球滤 过率（eGFR）。结果 正常对照组、单纯T2DM组、微量白蛋白尿组、大量白蛋白尿组HbA1c、Fib、D-二聚体及vWF依 次增加，而ADAMTS13依次降低（P＜0.05）。多元线性回归分析显示，白蛋白与D-二聚体是血清vWF的影响因素，而 D-二聚体是ADAMTS13水平的影响因素。ROC曲线分析显示，vWF诊断DN肾脏损伤敏感度较高，D-二聚体诊断 DN肾脏损伤敏感度和特异度较均衡，特异度更有优势。结论 血清vWF、ADAMTS13在糖尿病肾病的发生及发展中 可能起着重要作用，其水平可以成为DN早期的诊断和预测的参考指标。

Effects of plasma vWF and vWF lyase levels on diabetic nephropathy

Objective To explore the levels and their possible effects of serum von Willebrand factor (vWF) and vWF lyase (ADAMTS13) in patients with diabetic nephropathy (DN). Methods Fifty cases of healthy physical examination (the normal control group) and 144 patients with type 2 diabetes (the T2DM group) were selected in this study. According to the ratio of urine microalbumin to urine creatinine (ACR), the diabetic T2DM patients were divided into the simple diabetes group (n=42, ACR＜30 mg/g), the microalbuminuria group (n=56, 30 mg/g≤ACR?300 mg/g), and the macroalbuminuria group (n=46, ACR≥300 mg/g). The immunoturbidimetric method was used to detect vWF levels. The double antibody sandwich method was used to detect ADAMTS13 level, creatinine (sCr), urea nitrogen (BUN) and glycosylated hemoglobin (HbA1c). The glomerular filtration rate (eGFR), D-Dimer and fibrinogen (Fib) were estimated. Results HbA1c, Fib, D-dimer and vWF increased successively in the normal control group, the T2DM group, the microalbuminuria group and the macroalbuminuria group, while ADAMTS13 decreased in turn (P＜0.05). Multiple linear regression analysis showed that albumin and D-dimer were the main factors affecting serum vWF, and D-dimer was the main factor affecting ADAMTS13 levels. ROC curve analysis showed that vWF was more sensitive in diagnosing DN renal damage, while D-dimer had more balanced sensitivity and specificity in the diagnosis of DN renal damage, and specificity was more advantage. Conclusion Serum vWF and ADAMTS13 may play an important role in the occurrence and development of DN, and their levels can be used as clinical indicators for the early diagnosis and prediction of DN.