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目的:探讨2型糖尿病肾病(DN)不同阶段血清脂联素(APN)、血管内皮生长因子(VEGF)变化及其与氧化应激的关系。方法:将符合1999年WHO诊断标准的2型糖尿病患者根据24h尿蛋白排泄率分为3组,即正常白蛋白尿组(SDM)、微量白蛋白尿组(NA)、大量蛋白尿组(MA)。另设正常对照组(NC)。采用双抗夹心ELISA法检测DN患者血清APN、VEGF水平,采用比色法测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)含量。结果:①DN患者血清APN水平低于正常对照组;DN患者各组间比较,大量蛋白尿组的血清APN水平最低,差异有统计学意义(P<0.05);血清VEGF水平在NA、MA组明显高于SDM组和NC组,差异有统计学意义(P<0.05)。②与NC组比较,SOD活性及GSH-Px水平在糖尿病各组明显下降(P<0.01),MDA水平在NA组、MA组明显升高(P<0.01)。③糖尿病患者血清APN与UAER、MDA、VEGF浓度呈负相关(P<0.05),与SOD、GSH-Px呈显著正相关(P<0.01);血清VEGF浓度与病程、HbA1c、UAER、MDA的升高呈正相关(P<0.05),与SOD、GSH-Px呈显著负相关(P<0.01)。结论:DN患者血清APN、VEGF水平与氧化应激密切相关,低APN血症是2型糖尿病及DN发生的危险因素,VEGF升高可能是DN的危险因素。
Objective: To investigate the changes of serum adiponectin (APN) and vascular endothelial growth factor (VEGF) in different stages of type 2 diabetic nephropathy (DN) and its relationship with oxidative stress. Methods: Patients with type 2 diabetes mellitus who met the WHO diagnostic criteria of 1999 were divided into 3 groups based on the urinary protein excretion rate of 24 h: normal albuminuria group (SDM), microalbuminuria group (NA), massive proteinuria group (MA ). Another set of normal control group (NC). The levels of serum APN and VEGF in patients with DN were measured by double-antibody sandwich ELISA. The activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA), glutathione peroxidase (GSH-Px) content. Serum APN levels in patients with DN were lower than those in control subjects. Serum levels of APN in patients with DN were significantly lower than those in patients with DN (P <0.05); serum VEGF levels were significantly higher in NA and MA groups Higher than SDM group and NC group, the difference was statistically significant (P <0.05). ②Compared with NC group, SOD activity and GSH-Px level were significantly decreased in diabetic group (P <0.01), MDA level was significantly increased in NA group and MA group (P <0.01). (3) There was a negative correlation between serum APN and UAER, MDA and VEGF in diabetic patients (P <0.05), and positively correlated with SOD and GSH-Px (P <0.01); serum VEGF concentration and course of disease, HbA1c, UAER and MDA (P <0.05), but negatively correlated with SOD and GSH-Px (P <0.01). Conclusions: Serum levels of APN and VEGF are closely related to oxidative stress in patients with DN. Low APN is a risk factor for type 2 diabetes mellitus and DN, and elevated VEGF may be a risk factor for DN.