住院2型糖尿病患者血清脂蛋白(a)水平及与糖尿病肾病的关系

目的 研究2型糖尿病患者血清脂蛋白(a)水平的变化,探讨其与糖尿病肾病的关系.方法 2007年1月至2008年11月我院内分泌代谢科收治的2型糖尿病患者1238例,年龄15～89岁,记录血压、体质量及病程,入院第2天测定卒腹及餐后2 h血糖、血脂谱、肾功能及尿白蛋白排泄率,应用肾脏病膳食改良试验公式计算肾小球滤过率.分别根据患者年龄、尿白蛋白排泄率及脂蛋白(a)水平进行分层.采用t检验、方差分析、多元逐步回归分析等进行统计学分析.结果 不同年龄组患者血清脂蛋白(a)水平差异无统计学意义(F=1.144,P>0.05).大量蛋白尿组血清脂蛋白(a)水平显著高于正常蛋白尿组和微量蛋白尿组(F=4.113,P<0.05).研究队列按照血清脂蛋白(a)的四分位点分为四组,随着血清脂蛋白(a)水平的升高,尿白蛋白排泄率逐渐升高(F=7.877,P<0.01),而肾小球滤过率逐渐降低(F=4.479,P<0.01).血清脂蛋白(a)与血清总胆固醇、低密度脂蛋白胆固醇、尿白蛋白排泄率呈正相关(r值分别为0.152、0.169、0.18,均P<0.01),与肾小球滤过率呈负相关(r=-0.061,P<0.01).多元逐步同归分析结果显示:影响尿白蛋白排泄率的主要因素包括收缩压、血清脂蛋白(a)水平、低密度脂蛋白胆固醇、肾小球滤过率、年龄.结论 2型糖尿病患者血清脂蛋白(a)水平不受年龄、病程及血糖控制情况的影响,是尿白蛋白排泄率的独立影响因素.

Serum lipoprotein (a)in hospitalized patients with type 2 diabetes mellitus and its association with diabetic nephropathy

Objective To evaluate the correlation of serum lipoprotein (a) (Lp (a)) with diabetic nephropathy in hospitalized type 2 diabetes mellitus. Methods Lipid profile, blood glucose, serum creatinine and urinary albumin excretion rate (UAER) were measured in 1238 hospitalized type 2 diabetic patients from January 2007 to November 2008. The blood pressure, body weight and diabetes duration were recorded. Glomerular filtration rate (GFR) was estimated by the simplified MDRD equation, t test and multiple stepwise regression were used for data analysis. Results There was no significant difference in serum Lp (a) level among different age group (F = 1.144, P > 0.05). Serum Lp (a) level of macroalbuminuria group was significantly higher than that of nomoalbuminuria or microalbuminuria group (F = 4.113, P < 0.05). The cohort was divided into four groups by the quartile of serum Lp(a). It was demonstrated that UAER was increased with serum Lp(a) level while GFR decreased (F =7.877 or 4.479, P <0.01). Lp(a) showed positive correlations with total cholesterol, low-density lipoprotein cholesterol (LDL-C) and UAER (r =0.152, 0.169, and 0.18, P < 0.01) and a negative correlation with GFR (r = - 0.061, P < 0.01). Systolic pressure, Lp (a), LDL-C, GFR, and age were independent risk factors for UAER according to multiple stepwise regression analysis. Conclusions Serum Lp(a) level might be associated with the onset and progression of diabetic nephropathy regardless of age, diabetic duration and glycemic control.