Clinical significance of serum homocysteine detection in diabetic nephropathy
-
摘要:
目的 探讨分析糖尿病肾病中血清同型半胱氨酸（Hcy）的变化和其炎症因子的相关性。 方法 选取2012年2月~2016年8月于我院就诊的2型糖尿病肾病患者共160例，根据尿白蛋白排泄率和血肌酐水平分为单纯糖尿病组（DM组）、早期糖尿病肾病组（EDN组）、糖尿病肾病组（CDN组）和肾功能衰竭组（CRF组），以40例健康体检者作为对照组，比较各组患者的Hcy值及生化指标，分析Hcy其糖尿病肾病患者炎症因子IL-1、IL-6、TNF-α和hsCRP的相关性。 结果 5组患者比较，其GLU、HbA1c、UREA、Cr、TP、ALB、TCH和TG差异均有统计学意义（P<0.01）；Hcy差异有统计学意义（F=27.452，P<0.01）；hsCRP、TNF-α、IL-1和IL-6差异有统计学意义（P<0.01）；血清Hcy水平和hsCRP存在显著的正相关（r=0.624，P<0.01）、和TNF-α存在正相关（r=0.557，P<0.01）、和IL-1存在显著正相关（r=0.568，P<0.01）、和IL-6存在显著正相关（r=0. 417，P=0.017）。 结论 Hcy在糖尿病肾病中病情进展中具有重要作用，可作为糖尿病肾病患者肾血管损伤及病情进展评价的重要指标，且与hsCRP、IL-1、IL-6和TNF-α具有显著的相关性。 Abstract:Objective To study the serum homocysteine (Hcy) level in diabetic nephropathy patients and the its correlation of the inflammatory factors. Methods From February 2012 to August 2012, a total of 160 patients with type 2 diabetic nephropathy were selected in our hospital, according to the urinary albumin excretion rate and serum creatinine level, which is divided into diabetes mellitus group (DM group), early diabetic nephropathy (EDN) group, diabetic nephropathy group (CDN) and renal failure (CRF) group, 40 cases of healthy physical examination as the control group, comparing the patients’ Hcy level and their biochemical index in the five group patients, to analyze the correlation between the Hcy level and the inflammatory factor, such as IL-6, IL-1 TNF-α and hsCRP. Results GLU、HbA1c、UREA、Cr、TP、ALB、TCH and TG in the five group patients had no significant difference (P<0.01), the five patients of Hcy comparative differences were statistically significant (F=27.452,P<0.01), the inflammation indicator in the five patients, including hsCRP, TNF-α, IL-1 and IL-6 comparison had significant difference (P<0.01), the serum Hcy levels had significant positive correlation with hsCRP (r=0.624, P<0.01), the serum Hcy levels had significant positive correlation with TNF-α (r=0.557, P<0.01), the serum Hcy levels had significant positive correlation with IL-1 (r=0.568, P<0.01), serum Hcy levels had significant positive correlation with IL-6 (r=0. 417, P=0.017). Conclusion Hcy plays a great important role in the progression of diabetic nephropathy, it can be used as the important indexes for evaluation of renal vascular injury and disease progression in DN patients, and has significant positive correlation with hsCRP, IL-1, IL 6 and TNF-α. -
Key words:
- serum homocysteine /
- diabetic nephropathy /
- interleukin 1 /
- interleukin 6 /
- tumor necrosis factor-α
-
表 1 5组患者之间的一般资料对比
组别 n 年龄（岁） 性别（男/女） 体质量指数（kg/m2） 患病时间（年） DM组 42 57.7±6.5 17/25 22.43±1.89 5.2±4.1 EDN组 47 56.5±5.8 23/24 23.31±2.14 7.6±3.7* CDN组 44 57.1±6.3 21/23 22.83±1.77 9.1±3.3*△ CRF组 27 56.8±6.6 12/15 22.52±1.53 11.4±5.2*△□ 对照组 40 56.3±8.2 18/22 23.14±1.84 - P 0.121 0.944 0.314 <0.05 *P<0.05vs DM组；△P<0.05vs EDN组；□P<0.05vs CDN组. 
下载: 导出CSV
表 2 5组患者之间的生化及炎症指标对比
指标 GLU（mmol/L） HbA1c（%） UREA（mg/dL） Cr（μmol/L） TP（g/L） ALB（g/L） TCH（mmol/L） TG（mmol/L） hsCRP（mg/L） Hcy（μmol /L） TNF-α（pg/mL） IL-1（pg/mL） IL-6（pg/mL） DM组（n=42） 8.7±2.9* 7.2±1.3* 21.4±5.3 61.9±8.8 67.5±5.2 42.4±3.1 4.8±1.2 1.7±0.6 3.2（5.4）* 9.2±2.1* 3.2（3.3） 22.6（23.2）* 3.2（3.3）* EDN组（n=47） 9.8±3.2*△ 7.9±1.8* 126.4±12.6*△ 95.3±16.5*△ 60.7±8.7*△ 36.6±6.3*△ 5.1±1.2 2.0±0.8* 16.7（16.2）*△ 11.8±2.8*△ 9.7（8.6）*△ 48.7（42.5）*△ 4.4（4.6）*△ CDN组（n=44） 11.2±3.7*△□ 8.8±1.9*△□ 435.3±31.2*△□ 114.6±18.4*△□ 55.2±8.1*△□ 34.1±3.1*△ 5.2±1.3 1.9±0.7 27.3（28.2）*△□ 16.2±3.7*△□ 17.8（12.2）*△□ 67.8（47.2）*△□ 6.6（7.1）*△□ CRF组（n=42） 13.2±4.3*△□○ 9.1±2.2*△□ 664.3±41.3*△□○ 484.6±79.3*△□○ 47.7±5.9*△□○ 32.4±5.5*△□ 5.3±1.4* 2.2±0.6*□ 37.2（26.4）*△□○ 26.2±3.7*△□○ 24.5（21.4）*△□○ 78.4（57.6）*△□○ 8.4（7.1）*△□○ 对照组（n=40） 4.9±1.1 5.1±0.7 18.4±5.7 59.4±8.5 71.4±4.2 42.7±2.2 4.9±1.4 1.8±0.9 2.1（1.9） 7.2±3.4 2.8（1.7） 12.6（5.2） 2.1（1.4） P <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 0.217 0.186 <0.01 <0.01 <0.01 <0.01 <0.01 *P<0.05vs对照组；△P<0.05vs DM组；□P<0.05vs EDN组；○P<0.05vs CDN组.
下载: 导出CSV
表 3 Hcy与炎症指标的相关性分析
指标 r P hsCRP 0.624 <0.01 TNF-α 0.557 <0.01 IL-1 0.568 <0.01 IL-6 0.417 0.017
下载: 导出CSV
-
[1] Yano Y, Fujimoto S, Kramer H, et al. Long-term blood pressure variability, new-onset diabetes mellitus, and new-onset chronic kidney disease in the Japanese general population[J]. Hypertension, 2015, 66(1): 30-6. doi: 10.1161/HYPERTENSIONAHA.115.05472 [2] Blázquez AM, López JM, Martínez SC. Mechanisms involved in the Genesis of diabetic nephropathy[J]. Curr Diabetes Rev, 2010, 6(2): 68-87. doi: 10.2174/157339910790909422 [3] 张晓会, 赵 伟, 郑 晓, 等. 中性粒细胞与淋巴细胞比值与2型糖尿病微血管病变的相关性研究[J]. 中华内分泌代谢杂志, 2014, 30(9): 752-4. http://cdmd.cnki.com.cn/Article/CDMD-10393-1016224402.htm [4] Katagiri D, DoiK, Matsubara T, et al. New biomarker panel of plasma neutrophil gelatinase-associated lipocalin and endotoxin activity assay for detecting sepsis in acute kidney injury[J]. J Crit Care, 2013, 28(5): 564-70. doi: 10.1016/j.jcrc.2013.01.009 [5] 李仁达, 夏苏蕾. 糖尿病肾病患者与炎症因子及胰岛素抵抗关系的研究[J]. 宁夏医学杂志, 2007, 29(6): 520-2. http://www.cnki.com.cn/Article/CJFDTOTAL-NXYX200706016.htm [6] 亓海萍, 吕卫华, 武 琳. 糖化血红蛋白、同型半胱氨酸及尿微量白蛋白与2型糖尿病合并肾脏微血管病变的关系研究[J]. 中国实验诊断学, 2015, 19(11): 1840-3. http://www.cnki.com.cn/Article/CJFDTOTAL-ZSZD201511009.htm [7] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中国医学前沿杂志: 电子版, 2015, 22(3): 26-89. http://www.cnki.com.cn/Article/CJFDTOTAL-ZGTL201410001.htm [8] Zheng JM, Yao GH, Cheng Z, et al. Pathogenic role of mast cells in the development of diabetic nephropathy: a study of patients at different stages of the disease[J]. Diabetologia, 2012, 55(3): 801-11. doi: 10.1007/s00125-011-2391-2 [9] 李艳红, 黎 艳, 李 莉, 等. 维生素D联合盐酸吡格列酮干预对糖尿病肾病患者血清炎症因子的影响[J]. 广东医学, 2016, 37(1): 125-7. http://www.cnki.com.cn/Article/CJFDTOTAL-GAYX201601045.htm [10] 许敏玲, 袁 帅, 丁德良. 糖尿病肾病不同进展阶段的微炎症状态及其干预治疗研究[J]. 解剖学研究, 2010, 32(2): 121-5, 133. http://www.cnki.com.cn/Article/CJFDTOTAL-GDJP201002012.htm [11] Zanotti S, Canalis E. Hairy and enhancer of split-related with YRPW motif (HEY)2 regulates bone remodeling in mice[J]. J Biol Chem, 2013, 288(30): 21547-57. doi: 10.1074/jbc.M113.489435 [12] 甄卓丽, 陈晓铭, 周 飞, 等. 2型糖尿病肾病患者血清同型半胱氨酸水平的变化及意义[J]. 广东医学, 2015, 12(16): 2556-7. http://www.cnki.com.cn/Article/CJFDTOTAL-GAYX201516042.htm [13] 乔丽丽, 李冬娥. 血清同型半胱氨酸与2型糖尿病肾病的关系[J]. 中华全科医学, 2011, 9(6): 874-5. http://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201106026.htm [14] 周玉萍, 迟海燕, 王永笛. 糖尿病肾病不同分期血清同型半胱氨酸、三酰甘油、总胆固醇水平的变化[J]. 疑难病杂志, 2014, 13(11): 1137-9. doi: 10.3969/j.issn.1671-6450.2014.11.011 [15] Piwkowska A, Rogacka D, Audzeyenka I, et al. High glucose concentration affects the oxidant-antioxidant balance in cultured mouse podocytes[J]. J Cell Biochem, 2011, 112(6): 1661-72. doi: 10.1002/jcb.v112.6 [16] Fang X, Dong L, Chen WB, et al. Correlation of homocysteine with diabetic microangiopathy and the change after drug intervention[J]. J South Med Univ, 2016, 36(11): 1573-6. [17] 朱春海, 卢益中. 糖尿病患者血清C反应蛋白、肿瘤坏死因子α、白细胞介素6与微量白蛋白尿的关系研究[J]. 中国医师进修杂志, 2010, 33(31): 51-2. doi: 10.3760/cma.j.issn.1673-4904.2010.31.019 [18] Wada J, Makino H. Inflammation and the pathogenesis of diabetic nephropathy[J]. Clin Sci (Lond), 2013, 124(3/4): 139-52. [19] Fallahzadeh MK, Dormanesh B, Sagheb MM, et al. Effect of addition of silymarin to renin-angiotensin system inhibitors on proteinuria in type 2 diabetic patients with overt nephropathy: a randomized, double-blind, placebo-controlled trial[J]. Am J Kidney Dis, 2012, 60(6): 896-903. doi: 10.1053/j.ajkd.2012.06.005 -
点击查看大图
表(3)
计量
- 文章访问数: 528
- HTML全文浏览量: 213
- PDF下载量: 0
- 被引次数: 0
