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目的:观察2型糖尿病肾病(DN)患者血清脂联素(adiponectin,ADPN)水平变化及其临床意义。方法:正常对照组(NC)10例;2型糖尿病患者53例,根据尿白蛋白排泄率(UAER)及血清肌酐(SCr)水平分成糖尿病组(DM,UAER<30mg/g,SCr<132.6μmol/L)、糖尿病肾病组(DN1,≥30mg/g,SCr<132.6μmol/L)和晚期糖尿病肾病组(DN2,UAER≥300mg/g,SCr>132.6μmol/L);应用酶联免疫吸附法(ELISA)测定各组血清中的ADPN、可溶性血管细胞粘附分子1(sVCAM-1)水平。结果:DN2组的血清ADPN水平高于NC组、DM组和DN1组(P<0.05);DN1组的ADPN高于NC组和DM组,但无统计学差异;DM组的ADPN水平低于NC组,但无统计学差异。sVCAM-1在NC组、DM组、DN1组和DN2组依次逐渐增高。相关分析显示ADPN与尿酸(UA)、SCr、肾小球滤过率(eGFR)呈显著相关关系(P<0.05),多元逐步回归分析显示SCr是ADPN的独立相关因素(决定系数为r2=0.265,β=3.130,P<0.01)。无论在研究对象总体还是糖尿病患者中,ADPN与sVCAM-1均呈正相关性(相关系数分别为0.331,P<0.01;0.316,P<0.05)结论:2型糖尿病肾病患者血清ADPN水平升高可能与肾功能减退有关,血清ADPN升高可能参与了糖尿病肾病患者的内皮功能损害机制。
Objective: To observe the changes of serum adiponectin (ADPN) level and its clinical significance in type 2 diabetic nephropathy (DN). Methods: 10 cases of normal control group (NC) and 53 cases of type 2 diabetes mellitus were divided into diabetes group (UAER <30mg / g, SCr <132.6μmol) according to urinary albumin excretion rate (UAER) and serum creatinine / L), diabetic nephropathy group (DN1≥30mg / g, SCr <132.6μmol / L) and advanced diabetic nephropathy group (DN2, UAER≥300mg / g, SCr> 132.6μmol / L) Serum ADPN and soluble vascular cell adhesion molecule 1 (sVCAM-1) levels were measured by ELISA. Results: The level of ADPN in DN2 group was higher than that in NC group, DM group and DN1 group (P <0.05). The ADPN in DN1 group was higher than that in NC group and DM group, but not in DM group Group, but no statistical difference. sVCAM-1 gradually increased in NC group, DM group, DN1 group and DN2 group. Correlation analysis showed that there was a significant correlation between ADPN and UA, SCr and glomerular filtration rate (eGFR) (P <0.05). Multivariate stepwise regression analysis showed that SCr was an independent correlate of ADPN with a coefficient of determination of r2 = 0.265 , β = 3.130, P <0.01). There was a positive correlation between ADPN and sVCAM-1 in both study subjects and diabetic patients (correlation coefficient was 0.331, P <0.01; 0.316, P <0.05) .Conclusion: Serum ADPN levels in patients with type 2 diabetic nephropathy may be associated with Renal dysfunction, serum ADPN may be involved in the pathogenesis of endothelial dysfunction in patients with diabetic nephropathy.