2型糖尿病患者血清胆碱酯酶与肾脏病变的相关性  

Correlation between serum cholinesterase and renal disease in patients with type 2 diabetes mellitus

作　　者：刘苏[1] 王晓骁[1] 刘敬顺[1] LIU Su;WANG Xiaoxiao;LIU Jingshun(Department of Endocrinology,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210000,CHINA)

机构地区：[1]江苏省中医院(南京中医药大学附属医院)内分泌科,210000

出　　处：《江苏医药》2020年第4期346-349,355,共5页Jiangsu Medical Journal

基　　金：国家自然科学基金(81804027)。

摘　　要：目的探讨血清胆碱酯酶(S-ChE)与2型糖尿病(T2DM)患者糖尿病肾病(DKD)的相关性。方法回顾性分析1647例T2DM患者的临床资料。按肾小球滤过率(eGFR)水平将患者分为五组:A组,1009例,eGFR≥90 mL·min^-1·1.73m^-2;B组,460例,60 mL·min^-1·1.73m^-2≤eGFR<90 mL·min^-1·1.73m^-2;C组,85例,45 mL·min^-1·1.73m^-2≤eGFR<60 mL·min^-1·1.73m^-2;D组,53例,30 mL·min^-1·1.73m^-2≤eGFR<45 mL·min^-1·1.73m^-2;E组,40例,eGFR<30 mL·min^-1·1.73m^-2。检测S-ChE、肝肾功能、血视黄醇结合蛋白(RBP)、血脂、尿微量白蛋白肌酐比值(UACR)、尿蛋白定量(UTP)、尿-β-D-半乳糖酐酶(GAL)等指标,并计算BMI、eGFR和HOMA-IR等。采用Pearson或Spearman相关分析S-ChE与DKD肾损伤指标及影响因素的相关性;多重线性回归分析T2DM患者S-ChE的影响因素。结果A、B、C、D和E组患者S-ChE水平比较差异有统计学意义(P<0.05)。T2DM患者S-ChE水平与尿GAL、血RBP和eGFR呈正相关(P<0.05)。A组S-ChE与UACR、尿GAL、血RBP、eGFR呈正相关(P<0.05);B组S-ChE与血RBP、eGFR呈正相关(P<0.05);C组S-ChE与UTP、血RBP呈正相关(P<0.05);D组S-ChE与UTP、血RBP呈正相关(P<0.05),与尿GAL呈负相关(P<0.05);E组S-ChE与UTP、血RBP呈正相关(P<0.05)。多重线性回归分析结果显示,TG、LDL-C、HOMA-IR、BMI、尿酸、D-D、病程、RBC、Hb、白蛋白、Plt是T2DM患者S-ChE的独立影响因素(P<0.05)。结论T2DM患者S-ChE水平可以反映肾脏损伤,尤其是肾小球损伤的严重程度,是DKD病情评估的潜在监测指标。S-ChE可能通过胆碱能抗炎通路,参与了代谢性炎症引起的肾脏损伤。Objective To investigate the correlation between serum cholinesterase(S-ChE)and renal disease in the patients with type 2 diabetic mellitus(T2 DM).Methods The clinical data of 1647 patients with T2 DM were retrospectively analyzed.According to the level of glomerular filtration rate(eGFR),the patients were divided into five groups of A(eGFR≥90 mL·min^-1·1.73 m^-2,1009 cases),B(60 mL·min^-1·1.73 m^-2≤eGFR<90 mL·min^-1·1.73 m^-2,460 cases),C(45 mL·min^-1·1.73 m^-2≤eGFR<60 mL·min^-1·1.73 m^-2,85 cases),D(30 mL·min^-1·1.73 m^-2≤eGFR<45 mL·min^-1·1.73 m^-2,53 cases)and E(eGFR<30 mL·min^-1·1.73 m^-2,40 cases).Serum S-ChE,liver and kidney functions,blood retinol binding protein(RBP),blood lipids,urine microalbumin creatinine ratio(UACR),urine protein quantification(UTP),and urine-β-D-galactosidase(GAL)were measured.Body mass index(BMI),eGFR,and HOMA-IR were calculated.Pearson or Spearman correlation was used to analyze the correlation between S-ChE and DKD kidney injury indexes and influencing factors.Multiple linear regression was used to analyze the influencing factors of S-ChE in T2 DM patients.Results There were statistically significant differences in the levels of S-ChE among groups of A,B,C,D,and E(P<0.05).Serum level of S-ChE in T2 DM patients was positively correlated with urinary GAL,blood RBP and eGFR(P<0.05).S-ChE in group A was positively correlated with UACR,urine GAL,blood RBP and eGFR(P<0.05).S-ChE in group B was positively correlated with blood RBP and eGFR(P<0.05).S-ChE in group C was positively correlated with UTP and blood RBP(P<0.05).S-ChE in group D was positively correlated with UTP and blood RBP(P<0.05),and negatively correlated with urinary GAL(P<0.05).S-ChE in group E was positively correlated with UTP and blood RBP(P<0.05).Multiple linear regression analysis showed that TG,LDL-C,HOMA-IR,BMI,uric acid,D-D,disease course,RBC,Hb,albumin and Plt were the independent factors affecting S-ChE in T2 DM patients(P<0.05).Conclusion Serum level of S-ChE in T2 DM patients can refl

关 键 词：血清胆碱酯酶 糖尿病肾病 代谢性炎症 胆碱能抗炎通路 

分 类 号：R587[医药卫生—内分泌]