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  

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

作　　者：熊晓清[1,2] 冉建民[1,2] 刘薇[1,2] 郭顺华[1,3] 张人漪[1,2] 劳干诚[1,2] 

机构地区：[1]暨南大学医学院附属第四医院 [2]广州市红十字会医院内分泌科,广东省广州市510220 [3]广州市红十字会医院超声科,广东省广州市510220

出　　处：《中国动脉硬化杂志》2012年第3期247-251,共5页Chinese Journal of Arteriosclerosis

基　　金：广州市医药卫生科技资助项目(2005-YB-051)

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。Aim To investigate the level of plasma adiponectin in patients with diabetic nephropathy,and its relationship to vascular endothelial function.Methods Fifty 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）.Results In 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,P0.01 and P0.05）,while the difference between NAU group and MAU group was also significant（P0.05）.The ratio of adiponectin to serum creatinine followed the same trend along three groups（P0.05）.Plasma sVCAM-1 was significantly increased in MAU group and CAU group than that in NAU group（P0.01 and P0.05）.FMD and NID were signifi-cantly decreased in contrast to the increment of plasma adiponectin（P0.05）.IMT was comparable between three groups（P0.05）.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 P0.05）,while negatively correlated with FMD and NID（r=-0.397 and-0.413 respectively,P0.01）.Conclusions Diabetic 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.

关 键 词：脂联素 糖尿病肾病 血管内皮功能 

分 类 号：R5[医药卫生—内科学]