糖尿病肾病各时期内皮素水平的研究

目的探讨内皮素在糖尿病肾病（DN）各时期的水平，寻求内皮功能和相关因素关系与疾病程度的相关性。方法选取2型糖尿病患者136例，按蛋白尿及肾功能状况将DN分为无白蛋白尿期40例，微量蛋白尿期36例，临床蛋白尿期30例，肾功能不全期30例，与正常人及糖尿病前期（糖调节1期）各30例作对比，观察体重指数（BMI）、空腹血糖（FPS）、空腹胰岛素（FINS）、糖化血红蛋白（HbAlc）、尿白蛋白排泄率（UAER）、血内皮素（SET-1）、尿内皮素（UET一1）、血脂与血液流变学、肌酐清除率（Ccr）等变化。结果DN四个时期和糖尿病前期SET-1／UET-1、UAER、血脂与血液流变学与正常人相比差异均有统计学意义（P〈0．05或P〈0．01）。SET一1／UET．1、UAER与血脂、血液流变学呈进行性增高。SET-1、UET-1、UAER分别与FPG、HbAlc、血脂、血液流变学呈显著相关。结论DN各期均存在内皮功能障碍，其严重程度与SET-1／UET一1水平呈正相关系，SET—A／UET一1可作为临床判断内皮功能障碍程度和观察DN进展的一项重要指标。

Study on the change of endothelin contents in different period of diabetic nephropathy

Objective To explore the effects of endothelin in different period of diabetic nephropathy （DN） through investigation of the changes of endothelin. Methods One hundred and thirty-six patients with type 2 diabetes mellitus （T2DM） were divided into 4 groups. 40 patients without microalbuminuria period in DN0 group, 36 patients with mieroalbuminuria period in DN1 group, 30 patients over proteinuria period in DN2 group, 30 patients impaired renal function period in DN3 group according to level of microalbuminuria and renal function, and compared with 30 patients pre-diabetes mellitus （ impaired glucose regulation, IGR） （IGR group） and 30 normal people （NGT group）, and body mass index（BMI）, fasting plasma glucose（ FPG）, fasting serum insulin（FINS） , glyeosylated hemoglobin （HbAlc）, urine album in excretion ratio（ UAER ）, urine endothelin-1 （UET-1）, serum endothelin-1 （SET-1）, creatinine clearance rate（ Ccr）, serum lipid levels and hemorheology were detected in the observed objects. Results Compared with normal people, SET-1/UET-1, UAER, serum lipid levels, hemorheology were statistically significant （P 〈0. 01 or P〈0. 05）. SET-1/UET-1 and hemorheology increased with development of DN in different period of DN and pre-diabtes meUitus. UEAR, SET-l, UET-1 were respectively significantly correlated with FPG, HbAlc, serum lipid levels and hemorheology. Conclusion Endothelial dysfunction appears in each period of DN. Its severity was positively correlated with the SET-1/UET-1. SET-1/UET-1 can be used for predicting the degree of endothelial dysfunction and the progress of diabetic nephropathy in clinical diagnosis.