2型糖尿病肾病患者内脂素、同型半胱氨酸和高敏 C-反应蛋白变化及临床意义

摘要

目的：检测2型糖尿病患者血清内脂素、同型半胱氨酸（ Homocysteine ， Hcy ）和高敏 C-反应蛋白（ hs-CRP）水平，探讨三者在2型糖尿病肾病发生发展中的作用及临床意义。方法选择103例2型糖尿病患者，根据尿白蛋白排泄率（UAER）分为3组：正常蛋白尿组（UAER＜20μg/min）37例，微量蛋白尿组（UAER20～200μg/min）35例，大量蛋白尿组（ UAER ＞200μg/min ）31例；另选健康体检正常者32例为对照组。采用酶联免疫吸附法（ELISA）检测受检者内脂素、Hcy水平，免疫比浊法测定hsCRP。同时测定空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、尿素氮（BUN）、血肌酐（SCr）肾小球滤过率（GFR）、UAER，比较3组间的差异。结果3组患者血清内脂素、Hcy和hsCRP水平明显高于对照组（ P ＜0�．01）。相关性分析提示：内脂素、Hcy、hs-CRP均与 FPG、HbA1c、HOMA-IR、BUN、Scr、UAER 呈正相关（ r值分别为0．391、0．449、0．367、0．423、0．656、0．626、0．366、0．395、0．323、0．379、0．479、0．434、0．347、0．354、0．294、0．312、0．556、0．531， P ＜0．01），与GFR呈负相关（ r值分别为-0．423、-0．338、-0．354， P ＜0．01）。而内脂素、Hcy、hs-CRP之间也均呈正相关（ r值分别为0．786、0．557， P ＜0．05）。结论血清内脂素、Hcy和hs-CRP可能参与了2型糖尿病肾病的发生发展，作用方式可能为胰岛素抵抗及炎性反应，联合检测三者水平可能对评估早期糖尿病肾病有意义。%Objective To detect the serum levels of visfatin , homocysteine ( Hcy ) and high-sensitivity C reaction protein ( hsCRP ) in patients with type 2 diabetic nephropathy , and to explore their role and clinical significance in pathogenesis and progress of type 2 diabetic nephropathy ( DN ) .Methods A total of 103 patients with type 2 diabetes mellitus were divided into three groups according to the urinary albumin excretion rate ( UAER ): normal albuminuria group ( UAER<20μg/min, n =37 ) , micro-albuminuria group ( UAER 20 ~200μg/min, n =35 ) and macro-albuminuria group ( UAER>200μg/min, n =31 ) ,with 32 healthy subjects as controls .The serum levels of visfatin and Hcy were detected by enzyme linked immunosorbent assay (ELISA) and hsCRP levels were measured by immuno-turbidimetry.Furthermore,fasting plasma glucose ( FPG),HbA1c,fasting insulin (FINS),insulin resistance index (HOMA-IR),blood urea nitrogen (BUN), serum creatinine ( SCr) ,and glomerular filtration rate ( GFR) levels as well as UAER were detected and compared .Results The serum levels of visfatin ,Hcy and hsCRP in diabetic patients were significantly higher than those in control group ( P <0.01).The serum levels of visfatin,Hcy and hsCRP were positively correlated with those of FPG ,HbA1c,HOMA-IR,BUN,Scr and UAER ( P <0.01),however,which were negatively correlated to those of GFR (P<0.01).Furthermore the serum levels of visfatin,Hcy,hsCRP were positively correlated each other .Conclusion The visfatin,Hcy and hsCRP may play an important role in the pathogenesis and development of DN ,and the action mode may be insulin resistance and inflammatory response ,so combined detection may be useful for evaluating early DN .