尿胞外体1型辅助性T细胞／2型辅助性T细胞失衡与2型糖尿病肾病的相关性  

Correlation of imbalance of urinary exosome Th1/Th2 with diabetic nephropathy

作　　者：孙爱丽[1] 倪一虹[1] 关广聚[1] 邓浩萍[3] 刘元涛[1] 陈诗鸿[1] 孙福敦[1] 庄向华[1] 邓景惕[2] 胡晓燕[2] 

机构地区：[1]山东大学第二医院肾内科,济南250033 [2]山东大学医学院生化室 [3]山东省莱州市人民医院肾内科

出　　处：《中华肾脏病杂志》2011年第9期637-640,共4页Chinese Journal of Nephrology

基　　金：山东省自然科学基金

摘　　要：目的探讨2型糖尿病（DM）患者尿胞外体1型辅助性T细胞／2型辅助性T细胞（Th1／Th2）的变化与2型糖尿病肾病（DN）发生发展的相关性。方法选取120例2型糖尿病患者及健康对照组30例为对象，根据尿白蛋白肌酐比（UACR），2型糖尿病患者分为糖尿病非肾病组（DIM，40例，UACR〈30mg／gCr）、微量白蛋白尿组（DN1，50例，UACR≥30-300mg／gCr）和临床白蛋白尿组（DN2，30例，UACR〉300mg／gCr）。用特异性单克隆抗体提纯尿胞外体。用酶联免疫吸附法（ELISA）检测尿胞外体干扰素1（IFN-γ）和白细胞介素4（IL-4）水平。用多元逐步回归方法分析尿胞外体IFN-γ／IL-4比值与糖化血红蛋白（HbA1c）、胆固醇（CH）、UACR、血肌酐（Scr）、尿素氮（BUN）相关性。结果DM、DN1、DN2组胞外体Th1／Th2水平显著高于健康对照组（0．8089±0．2458、0．8993±0．3515、0．8571±0．2470比0．6198±0．1769，均P〈0．01）。DN1组胞外体Th1／Th2显著高于DM组（P〈0．01）。尿胞外体IFN-γ／IL-4与UACR（r=0．213，P=0．015）、BUN（r=0．292，P=0．001）呈正相关。逐步多元回归分析显示，BUN是尿胞外体IFN-γ／IL．4的独立影响因素（β=0．246，P=0．006）。结论尿胞外体Th1／Th2漂移与2型糖尿病肾病密切相关，可能在糖尿病早期肾病发病过程中起重要的作用。Objective To examine the correlation of imbalance of urinary exosome Thl/ Th2 with diabetic nephropathy （DN）. Methods A total of 120 patients with type 2 diabetes mellitus （DM） and 30 healthy volunteers as control were enrolled in the study. According to urinary albumin/creatinine ratio （UACR）, type 2 diabetes mellitus patients were divided into 3 groups： diabetes mellitus without nepbropatby group （DM, n=40, UACR〈30 mg/gCr）, mieroalbuminuria group （DN 1, n=50, UACR-30-300 mg/gCr） and elinicoalbuminnria group （DN 2, n=30, UACR〉 300 mg/gCr）. Urine exosome-interferon-gamma （IFN-γ） and exosome-interleukin 4 （IL-4） levels were determined lay enzyme-linked immunosorbent assay （ELISA）. Muhiple stepwise linear regression was used to analyze the correlation of exosome-IFN-γ/IL-4 with glycated hemoglobin （HbAle）, cholesterol （CH）, UACR, Scr and BUN. Results Th1/Th2 ratio in DM, DN1, DN2 groups was significantly higher than that in healthy group （0.8089±0.2458, 0.8993 ±0.3515, 0.8571±0.2470 vs 0.6198±0.1769, all P〈0.01）. Correlation analysis showed that urinary exosomc- IFN-γ/IL-4 ratio was positively correlated with UACR （r=0.213, P=0.015） and BUN （r=0.292, P= 0.001）. Multiple stepwise linear regression analysis showed that BUN was independent determinants for exosome-IFN-γ/IL-4 （/3=0.246, P=0.006）. Conclusion The imbalance of urinary exosomeTh1/Th2 is correlated with DN,whieh may play an important role in the pathogenesis of DN.

关 键 词：糖尿病肾病 白蛋白尿 尿胞外体 TH1细胞 TH2细胞 

分 类 号：R587.2[医药卫生—内分泌]