糖尿病肾病患者血清和肽素、脂联素水平变化及其与肾动脉血流阻力指数的相关性
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摘要
目的探讨糖尿病肾病(DN)患者血清和肽素、脂联素水平变化及其与肾动脉血流阻力指数(RI)的关系。方法选取2015年8月至2017年8月收治的2型糖尿病(T2MD)患者140例作为研究对象,根据24h尿清蛋白排泄率(UAER)分为3组,UAER<30 mg/24h为单纯糖尿病组61例,UAER为30～300mg/24h为微量清蛋白尿组44例,UAER>300mg/24h为大量清蛋白尿组35例,另从体检中心选取年龄、性别匹配的体检健康者50例作为对照组,检测4组血清和肽素、脂联素水平,采用彩色多普勒超声取肾门处主动脉(MRA)、肾窦部的段动脉(SRA)、皮髓交界处的叶间动脉(IRA)检测收缩期峰值速度(PSV)、舒张末期血流速度(EDV),并计算阻力值(RI)。结果和肽素、脂联素水平在大量清蛋白尿组、微量清蛋白尿组、单纯糖尿病组、对照组中为逐渐降低趋势,4组差异具有统计学意义(P<0.05);MRA、SRA、IRA的PSV、EDV值在单纯糖尿病组、微量清蛋白尿组、大量清蛋白尿组中为逐渐降低趋势,RI为逐渐升高趋势,3组比较差异有统计学意义(P<0.05),单纯糖尿病组各级肾动脉的PSV、EDV、RI值与对照组比较,差异无统计学意义(P>0.05);和肽素、脂联素与各级肾动脉PSV、EDV呈负相关(P<0.05),与各级肾动脉RI值呈正相关(P<0.05)。结论 DN患者血清和肽素、脂联素水平与各级肾动脉血流参数有关,与RI相关性尤为明显。
Objective To investigate the changes of serum copeptin and adiponectin levels in patients with diabetic nephropathy(DN)and the relationship with the renal artery resistance index(RI).Methods 140 patients with type 2 diabetes mellitus(T2 MD)who were admitted during the period from August 2015 to August 2017 were selected as the subjects.According to the 24 hurinary albumin excretion rate(UAER),they were divided into 3 groups,namely,the simple DM group(UAER<30 mg/24 h,61 cases),the microalbuminuria group(UAER of 30-300 mg/24 h,44 cases)and the macroalbuminuria group(UAER>300 mg/24 h,35 cases).Another 50 healthy people with matched age and gender were selected as the control group.The serum copeptin and adiponectin levels in the 4 groups were detected.The peak systolic velocities(PSV)and the enddiastolic velocities(EDV)of main renal artery(MRA)at the renal hilum,segmental renal artery(SRA)at renal sinus and interlobar renal artery(IRA)at the junction of cortex and medulla were detected by color Doppler ultrasound.The resistance index(RI)was calculated.Results Levels of copeptin and adiponectin in the macroalbuminuria group,the microalbuminuria group,the simple DM group and the control group showed agradually decreasing trend,and the difference was statistically significant among the four groups(P<0.05).The PSV and EDV of MRA,SRA and IRA in the simple DM group,the microalbuminuria group and the macroalbuminuria group also showed a gradually decreasing trend while the RI showed a gradually increasing trend,and the differences were statistically significant among three groups(P<0.05).There was no significant difference in the PSV,EDV or RI of renal arteries at all levels between the macroalbuminuria group and the control group(P>0.05).Copeptin and adiponectin were negatively correlated with the PSV and EDV of renal arteries at all levels(P<0.05),positively correlated with the RI of renal arteries at all levels(P<0.05).Conclusion The levels of serum copeptin and adiponectin in patients with DN are related to the parameters of renal artery blood flow at all levels,and the correlation with RI is particularly obvious.
Objective To investigate the changes of serum copeptin and adiponectin levels in patients with diabetic nephropathy(DN)and the relationship with the renal artery resistance index(RI).Methods 140 patients with type 2 diabetes mellitus(T2 MD)who were admitted during the period from August 2015 to August 2017 were selected as the subjects.According to the 24 hurinary albumin excretion rate(UAER),they were divided into 3 groups,namely,the simple DM group(UAER<30 mg/24 h,61 cases),the microalbuminuria group(UAER of 30-300 mg/24 h,44 cases)and the macroalbuminuria group(UAER>300 mg/24 h,35 cases).Another 50 healthy people with matched age and gender were selected as the control group.The serum copeptin and adiponectin levels in the 4 groups were detected.The peak systolic velocities(PSV)and the enddiastolic velocities(EDV)of main renal artery(MRA)at the renal hilum,segmental renal artery(SRA)at renal sinus and interlobar renal artery(IRA)at the junction of cortex and medulla were detected by color Doppler ultrasound.The resistance index(RI)was calculated.Results Levels of copeptin and adiponectin in the macroalbuminuria group,the microalbuminuria group,the simple DM group and the control group showed agradually decreasing trend,and the difference was statistically significant among the four groups(P<0.05).The PSV and EDV of MRA,SRA and IRA in the simple DM group,the microalbuminuria group and the macroalbuminuria group also showed a gradually decreasing trend while the RI showed a gradually increasing trend,and the differences were statistically significant among three groups(P<0.05).There was no significant difference in the PSV,EDV or RI of renal arteries at all levels between the macroalbuminuria group and the control group(P>0.05).Copeptin and adiponectin were negatively correlated with the PSV and EDV of renal arteries at all levels(P<0.05),positively correlated with the RI of renal arteries at all levels(P<0.05).Conclusion The levels of serum copeptin and adiponectin in patients with DN are related to the parameters of renal artery blood flow at all levels,and the correlation with RI is particularly obvious.
引文
[1] THOMAS M C,COOPER M E,ZIMMET P.Changing epidemiology of type 2diabetes mellitus and associated chronic kidney disease[J].Nat Rev Nephrol,2015,12(2):73.
[2] SNCHEZ-HERNNDEZ R M,GARCA-CANTN C,LORENZO D L,et al.The specific relationship between vitamin D deficiency and diabetic nephropathy among patients with advanced chronic kidney disease:a cross-sectional study in Gran Canaria,Spain[J].Clin Nephrol,2015,83(4):218-224.
[3]赵明,王丽,洪林巍.糖尿病肾病彩色多普勒肾血流显像在中医辨证分型中的应用[J].中华中医药学刊,2015,33(1):120-121.
[4]高文香,徐卫霞,龙丽,等.妊娠期高血压疾病患者血清和肽素水平及临床价值[J].中国妇幼保健,2016,31(5):954-956.
[5]赵菊兰,李颖,夏天.替米沙坦对单纯性肥胖小鼠血清脂联素及尿微量清蛋白的影响[J].中华肾脏病杂志,2015,31(12):919-923.
[6]赵昔良,叶益聪,张抒扬.美国糖尿病学会新版糖尿病诊断标准对择期冠状动脉造影患者糖代谢异常的筛查意义[J].中华内科杂志,2015,54(4):302-306.
[7]童国玉,朱大龙.糖尿病肾病国内外临床指南和专家共识解读[J].中国实用内科杂志,2017,37(3):211-216.
[8] POZSONYI Z,FRHCZ Z,GOMBOS T,et al.Copeptin(C-terminal pro Arginine-Vasopressin)is an independent long-term prognostic marker in heart failure with reduced ejection fraction[J].Heart Lung Circ,2015,24(4):359.
[9] CARSON D S,GARNER J P,HYDE S A,et al.Arginine Vasopressin is a blood-based biomarker of social functioning in children with autism[J].Plos One,2015,10(7):e0132224.
[10]ENHRNING S,BO H,NILSSON P M,et al.Copeptin is an independent predictor of diabetic heart disease and death[J].Am Heart J,2015,169(4):549-556.
[11]ZITTEMA D,BOERTIEN W E,BEEK A P V,et al.Vasopressin,copeptin,and renal concentrating capacity in patients with autosomal dominant polycystic kidney disease without renal impairment[J].Clin J Am Soc Nephrol Cjasn,2012,7(6):906.
[12]BJORNSTAD P,MAAHS D M,JENSEN T,et al.Elevated copeptin is associated with atherosclerosis and diabetic kidney disease in adults with type 1diabetes[J].J Diabetes Complications,2016,30(6):1093-1096.
[13]HONG R,DONG L Q.Adiponectin signaling and function in insulin target tissues[J].J Mol Cell Biol,2016,8(2):101.
[14]ESFAHANI M,MOVAHEDIAN A,BARANCHI M,et al.Adiponectin:an adipokine with protective features againstmetabolicsyndrome[J].IranJ Basic Med Sci,2015,18(5):430.
[15]MARKAKI A,PSYLINAKIS E,SPYRIDAKI A.Adiponectin and end-stage renal disease[J].Hormones,2016,15(3):345.
[16]成蔚,刘玲玲,潘金英,等.终末期肾病患者不同透析方式下血浆成纤维细胞生长因子21水平及临床意义[J].肾脏病与透析肾移植杂志,2015,24(6):529-533.
[17]胡文,郝海荣,邵小娟,等.血清和肽素水平及肾血流参数对2型糖尿病患者肾功能状况的判断价值[J].山东医药,2016,56(32):66-68.
[18]贺雪华,关步云,朱莉玲,等.彩色多普勒超声对儿童糖尿病肾动脉血流动力学变化的研究[J].中国医学影像学杂志,2015,23(4):273-276.
[19]张飞娟,陈晨,冯淑芝,等.胰激肽原酶对糖尿病肾病患者肾功能及血流动力学的影响[J].山东医药,2016,56(6):73-75.
[20]薛得文,袁萍,李峰,等.彩色多普勒超声在早期糖尿病肾病的应用[J].中国实用内科杂志,2014,34(s1):124-126.
[2] SNCHEZ-HERNNDEZ R M,GARCA-CANTN C,LORENZO D L,et al.The specific relationship between vitamin D deficiency and diabetic nephropathy among patients with advanced chronic kidney disease:a cross-sectional study in Gran Canaria,Spain[J].Clin Nephrol,2015,83(4):218-224.
[3]赵明,王丽,洪林巍.糖尿病肾病彩色多普勒肾血流显像在中医辨证分型中的应用[J].中华中医药学刊,2015,33(1):120-121.
[4]高文香,徐卫霞,龙丽,等.妊娠期高血压疾病患者血清和肽素水平及临床价值[J].中国妇幼保健,2016,31(5):954-956.
[5]赵菊兰,李颖,夏天.替米沙坦对单纯性肥胖小鼠血清脂联素及尿微量清蛋白的影响[J].中华肾脏病杂志,2015,31(12):919-923.
[6]赵昔良,叶益聪,张抒扬.美国糖尿病学会新版糖尿病诊断标准对择期冠状动脉造影患者糖代谢异常的筛查意义[J].中华内科杂志,2015,54(4):302-306.
[7]童国玉,朱大龙.糖尿病肾病国内外临床指南和专家共识解读[J].中国实用内科杂志,2017,37(3):211-216.
[8] POZSONYI Z,FRHCZ Z,GOMBOS T,et al.Copeptin(C-terminal pro Arginine-Vasopressin)is an independent long-term prognostic marker in heart failure with reduced ejection fraction[J].Heart Lung Circ,2015,24(4):359.
[9] CARSON D S,GARNER J P,HYDE S A,et al.Arginine Vasopressin is a blood-based biomarker of social functioning in children with autism[J].Plos One,2015,10(7):e0132224.
[10]ENHRNING S,BO H,NILSSON P M,et al.Copeptin is an independent predictor of diabetic heart disease and death[J].Am Heart J,2015,169(4):549-556.
[11]ZITTEMA D,BOERTIEN W E,BEEK A P V,et al.Vasopressin,copeptin,and renal concentrating capacity in patients with autosomal dominant polycystic kidney disease without renal impairment[J].Clin J Am Soc Nephrol Cjasn,2012,7(6):906.
[12]BJORNSTAD P,MAAHS D M,JENSEN T,et al.Elevated copeptin is associated with atherosclerosis and diabetic kidney disease in adults with type 1diabetes[J].J Diabetes Complications,2016,30(6):1093-1096.
[13]HONG R,DONG L Q.Adiponectin signaling and function in insulin target tissues[J].J Mol Cell Biol,2016,8(2):101.
[14]ESFAHANI M,MOVAHEDIAN A,BARANCHI M,et al.Adiponectin:an adipokine with protective features againstmetabolicsyndrome[J].IranJ Basic Med Sci,2015,18(5):430.
[15]MARKAKI A,PSYLINAKIS E,SPYRIDAKI A.Adiponectin and end-stage renal disease[J].Hormones,2016,15(3):345.
[16]成蔚,刘玲玲,潘金英,等.终末期肾病患者不同透析方式下血浆成纤维细胞生长因子21水平及临床意义[J].肾脏病与透析肾移植杂志,2015,24(6):529-533.
[17]胡文,郝海荣,邵小娟,等.血清和肽素水平及肾血流参数对2型糖尿病患者肾功能状况的判断价值[J].山东医药,2016,56(32):66-68.
[18]贺雪华,关步云,朱莉玲,等.彩色多普勒超声对儿童糖尿病肾动脉血流动力学变化的研究[J].中国医学影像学杂志,2015,23(4):273-276.
[19]张飞娟,陈晨,冯淑芝,等.胰激肽原酶对糖尿病肾病患者肾功能及血流动力学的影响[J].山东医药,2016,56(6):73-75.
[20]薛得文,袁萍,李峰,等.彩色多普勒超声在早期糖尿病肾病的应用[J].中国实用内科杂志,2014,34(s1):124-126.