血浆内皮微粒在糖尿病肾病患者内皮损伤机制中的作用  

The role of plasma endothelial microparticles in endothelial injury in diabetic patients

作　　者：孙志平[1] 赵冬兰 吕莎[1] 张静 耿瑞丽[4] 刘建辉[4] SUN Zhiping;ZHAO Donglan;LU Sha;ZHANG Jing;GENG Ruili;LIU Jianhui(Department of Laboratory Medicine,Hebei Chest Hospital,Shjiazhuang,Hebei 050041,China;Department of Laboratory Medicine,Shijiazhuang People's Hospital,Shjiazhuang,Hebei 050031,China;The Second Policlinic of Hebei Province,Shijiazhuang,Hebei 050051,China;Department of Blood Transfusion,Hebei General Hospital,Shijiazhuang,Hebei 050051,China)

机构地区：[1]河北省胸科医院检验科,河北石家庄050041 [2]石家庄市人民医院检验科,河北石家庄050031 [3]河北省直属机关第二门诊部,河北石家庄050051 [4]河北省人民医院输血科,河北石家庄050051

出　　处：《热带医学杂志》2023年第4期476-479,497,共5页Journal of Tropical Medicine

基　　金：河北省医学科学研究课题计划项目(20190353)。

摘　　要：目的探讨内皮微粒(EMP)在糖尿病肾病患者内皮细胞凋亡机制中的作用。方法糖尿病组、糖尿病肾病组患者各25例,另选择同期健康体检者25人作为正常对照组。应用罗氏全自动生化分析仪常规检测糖尿病患者及糖尿病肾病患者胆固醇(CHO)、甘油三酯(TG)、糖化血红蛋白(HbA1c)及血清胱抑素C(CysC)水平,ELISA方法检测血浆E-选择素(E-selectin)、可溶性Fas蛋白(sFas)/可溶性Fas蛋白配体(sFasL)水平,应用流式细胞术检测血浆中EMP、CD62E^(+)EMP和CD31^(+)EMP的水平及计算CD62E^(+)/CD31^(+)EMP的比例。结果糖尿病肾病组和糖尿病组CHO、TG、HbA1c及CysC水平均明显高于正常对照组,且糖尿病肾病组CysC水平显著高于糖尿病组,差异均有统计学意义(P均<0.01)。糖尿病肾病组和糖尿病组血浆EMP、E-selectin、sFas、sFasL水平明显高于正常对照组,且糖尿病肾病组各指标均明显高于糖尿病组,差异均有统计学意义(P均<0.01)。糖尿病肾病组CD62E^(+)/CD31^(+)EMPs的比值为(0.9±0.1),明显低于糖尿病组(8.8±0.3)和正常对照组(5.3±0.2),差异有统计学意义(F=54.36,P<0.01)。对EMP与各变量进行相关性分析,结果显示EMP与TG、HbA1c、CysC、E-selectin、sFas、sFasL水平均成正相关(P均<0.05),其中与CysC水平的相关性最高(r=0.76,P<0.01)。结论糖尿病肾病患者血浆EMP、E-selectin、sFas、sFasL、CysC水平明显升高,显示糖尿病肾病患者微血管并发症发病机制中出现内皮细胞损伤;CD62E^(+)/CD31^(+)EMPs的比例低于1,提示其中细胞凋亡在内皮损伤机制中占有着重要作用,可用来指导糖尿病及其并发症的预防和治疗。Objective To explore the role of endothelial particles(EMP)in endothelial cell apoptosis mechanism in diabetic nephropathy.Methods There were 25 patients in diabetic group and diabetic nephropathy group,and 25 patients with healthy physical examination in the same period were selected as the normal control group.The levels of cholesterol,triglyceride,glycosylated hemoglobin and serum cystatin C in diabetic patients and diabetic nephropathy patients were detected by Roche automatic biochemical analyzer.Plasma E-selectin and sFas/sFasL levels were detected by ELISA,and EMP,CD62E^(+)EMP,CD31^(+)EMP in plasma was detected by flow cytometry.Proportion of CD62E^(+)/CD31^(+)EMP was calculated.Results The levels of serum cholesterol,triglyceride,glycosylated hemoglobin and cystatin C in diabetic nephropathy and diabetes group were significantly higher than those in normal control group,and the level of cystatin C in diabetic nephropathy group was significantly higher than that in diabetes group(P<0.01).The levels of plasma EMP,E-selectin,sFas and sFasL in diabetic nephropathy and diabetes group were significantly higher than those in normal control group(P<0.01);the indexes in diabetic nephropathy group were significantly higher than those in diabetic group(P<0.01).The proportion of CD62E^(+)/CD31^(+)EMPs in patients with diabetic nephropathy was 0.91,which was significantly lower than that in diabetic group and normal control group(F=54.36,P<0.01).The correlation analysis between EMP and various variables showed that EMP was positively correlated with TG,HbA1c,CysC,E-selectin,sFas and sFasL levels(all P<0.05);among which,the correlation with CysC level was the highest(r=0.76,P<0.01).Conclusions The levels of plasma EMP,E-selectin,sFas,sFasL and CysC in patients with diabetic nephropathy increased significantly,indicating that endothelial cell injury was found in the pathogenesis of microvascular complications in diabetic nephropathy patients.The ratio of CD62E^(+)/CD31^(+)EMPs was less than 1,suggesting that apoptosis m

关 键 词：糖尿病 肾病 内皮微粒 E-选择素 胱抑素C 

分 类 号：R587.2[医药卫生—内分泌]