糖尿病肾病患者血脂异常及血清脂蛋白(a)与糖尿病肾病的关系

目的研究糖尿病肾病患者血脂变化及血清脂蛋白(a)[Lp(a)]与糖尿病肾病(DN)的关系。方法将110例2型糖尿病患者分为正常蛋白尿组(A组,43例)、微量蛋白尿组(B1组,37例)和大量蛋白尿组(B2组,30例)3组,分别检测其血脂及脂蛋白(a)水平,并与对照组(50例)比较。结果与对照组比较,2型糖尿病患者各组甘油三脂(TG)、低密度脂蛋白胆固醇(LDLC)和Lp(a)水平均升高,B1组、B2组与A组比较及B2组与B1组比较,Lp(a)均升高,差异有显著性(P<0.01);B1组、B2组胆固醇(TC)水平升高及高密度脂蛋白胆固醇(HDLC)、载脂蛋白A1(ApoA1)水平降低,B2组载脂蛋白B(ApoB)水平升高,差异有显著性(P<0.01);TG、LDLC、ApoB的升高与尿白蛋白排泄率(UAER)呈正相关,TG、LDLC升高与空腹血糖(FBG)呈正相关。Lp(a)与尿白蛋白排泄率呈正相关,与其它血脂变化无相关性。结论脂蛋白(a)水平升高可能继发于糖尿病肾病的肾脏损害,随肾脏损害的加重而逐步升高;高脂血症促进糖尿病肾病的发生和发展,糖尿病则加重血脂紊乱,形成恶性循环。

Relation of blood lipid abnormity and serum lipoprotein (a) with diabetic nephropathy

Objective To study the relationship between serum lipoprotein (a) and diabetic nephropathy,and the blood lipid variety of diabetic nephropathy.Methods One hundred and ten cases of patients with type 2 diabetic and with different-stage diabetic nephropathy were selected and divided randomly into normal-protein-urine group (Group A,n=43),micro-protein-urine group (Group B1,n=37) and large-protein-urine group (Group B2,n=30).Their lipoprotein (a),blood lipid,apolipoprotein (Apo) were measured respectively and compared with normal healthy subjects (control group).Results The levels of triacylglycerol (TG),low-density-lipoprotein (LDL),lipoprotein (a) in type 2 diabetic group were increased compared with the control group.The concentration of lipoprotein (a) in Group B1 and Group B2 was significantly higher than that in Group A.Moreover,the concentration of lipoprotein (a) in Group B2 was higher than that in Group B1 (P <0.01).The level of cholesterol was increased and the level of high-density lipoprotein and apolipoprotein (a) were decreased in Group B1 and Group B2.The concentration of apolipoprotein B in Group B2 was significantly increased(P <0.01).There was a positive correlation between increased TG,LDL,Apo(B) and urinary albumin excretion rate,and between enhanced TG,LDL and fasting plasma glucose(P <0.01).Apolipoprotein (a) was positive correlation with urinary albumin excretion rate, and no-positive correlation with other blood lipids. Conclusions Increased lipoprotein (a) may be consistent with kidney damage.Diabetics can aggravate blood lipid turbulence.