2型糖尿病合并糖尿病肾病脂联素水平变化及与血管内皮功能的关系
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广州市医药卫生科技资助项目 (2005-YB-051)


Alteration of Plasma Adiponectin and Its Relationship to Vascular Endothelial Function in Type 2 Diabetic Patients with Diabetic Nephropathy
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    摘要:

    目的探讨糖尿病肾病患者血清脂联素水平的变化,及与血管内皮功能的关系。方法50例无明显临床大血管并发症的2型糖尿病患者,按24 h尿白蛋白排出量分为正常白蛋白尿组、微量白蛋白尿组及大量白蛋白尿组。检测血清脂联素、可溶性血管细胞黏附分子1、生物化学指标、肱动脉内皮依赖性舒张功能(FMD)、含服硝酸甘油后肱动脉内皮依赖性舒张功能(NID)、心脏结构参数及颈动脉内膜-中膜厚度。结果大量白蛋白尿组脂联素水平是正常白蛋白尿组的4倍,是微量白蛋白尿组的2倍(p<0.01和p<0.05)。微量白蛋白尿组脂联素水平比正常白蛋白尿组升高(p<0.05)。脂联素/血肌酐在三组中有同样的变化(均p<0.05)。大量白蛋白尿组和微量白蛋白尿组可溶性血管细胞黏附分子1均高于正常白蛋白尿组(p<0.01和p<0.05)。大量白蛋白尿组FMD、NID随脂联素水平的增加而下降(p<0.05)。颈动脉内膜-中膜厚度在三组间无统计学差异。脂联素与可溶性血管细胞黏附分子1、24 h尿白蛋白排出量、血肌酐、左心室后壁厚度、内膜-中膜厚度呈正相关(r值分别为0.338、0.704、0.470、0.331、0.324,p<0.05),与FMD、NID 呈显著负相关(r值为-0.397、-0.413,p<0.01)。结论糖尿病肾病伴随高脂联素血症,且与血管内皮功能损害密切相关。脂联素可作为糖尿病肾病患者早期血管内皮功能障碍的预测指标。

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    AimTo investigate the level of plasma adiponectin in patients with diabetic nephropathy, and its relationship to vascular endothelial function.MethodsFifty type 2 diabetic patients without clinical macrovascular complications were randomly assigned to normal albuminuria group(NAU), microalbuminuria group(MAU) and macroalbuminuria group(CAU) according to the daily urinary albumin excretion (UAE).Plasma adiponectin, soluble vascular cell adhesion molecule-1(sVCAM-1) and other biochemical indexes were measured.Color Doppler examination was followed to evaluate flow-mediated vasodilation (FMD), nitroglycerin vasodilation (NID), cardiologic parameters and intima-media thickness (IMT).ResultsIn CAU group, plasma concentration of adiponectin was 4-fold and 2-fold higher than that in NAU group and MAU group respectively (13.3±5.0 mg/L vs 3.7±1.6 mg/L vs 5.7±2.2 mg/L, p<0.01 and p<0.05), while the difference between NAU group and MAU group was also significant (p<0.05).The ratio of adiponectin to serum creatinine followed the same trend along three groups (p<0.05).Plasma sVCAM-1 was significantly increased in MAU group and CAU group than that in NAU group (p<0.01 and p<0.05).FMD and NID were signifi-cantly decreased in contrast to the increment of plasma adiponectin (p<0.05).IMT was comparable between three groups (p>0.05).Finally, adiponectin was positively correlated with sVCAM-1, UAE, creatinine, left ventricular posterior wall thickness and IMT(r=0.338, 0.704, 0.470, 0.331, 0.324 respectively,all p<0.05), while negatively correlated with FMD and NID (r=-0.397 and -0.413 respectively, p<0.01).ConclusionsDiabetic nephropathy is accompanied with hyperadiponectinemia, which is closely related to vascular endothelial dysfunction.Adiponectin may act as an early predictor of vascular endothelial dysfunction in these patients.

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熊晓清,冉建民,刘薇,郭顺华,张人漪,劳干诚.2型糖尿病合并糖尿病肾病脂联素水平变化及与血管内皮功能的关系[J].中国动脉硬化杂志,2012,20(3):247~251.

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  • 收稿日期:2011-05-01
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